A combined anterolateral thigh flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the anterior mandible

The technique of lower anterior facial reconstruction using a combination of an anterolateral thigh flap (ALTF) and a microvascular iliac crest flap is described and the results of 18 cases are reported. Eleven patients suffered recurrence after surgery and radiotherapy of oral squamous cell carcinoma of the lower face. These patients underwent a second surgery and reconstruction. In seven patients reconstruction was performed during primary surgical therapy, followed by postoperative radiotherapy. The pedicle of the ALTF was used for elongation of the iliac crest pedicle. There were no problems with the pedicle length and anastomoses even in patients who had received previous surgery and irradiation of the neck. There was no flap loss. There were no severe postoperative complications. One patient had distant metastases 18 months postoperatively. In all other patients there was no tumour recurrence or metastasis within 10–43 months of follow-up. The ALTF and vascularized iliac bone flap combination is useful in reconstruction of the lower face. The main advantage is the elongation of the iliac flap pedicle by the ALTF pedicle in patients with previous surgery in the neck.