Prelamination of the Anterolateral Thigh Flap With a Fibula Graft to Successfully Reconstruct a Mandibular Defect

Flap prelamination is the process whereby a complex 3-dimensional construct is fashioned in a staged manner. We present a case whereby the tissues of the anterolateral thigh, nourished by perforators of the descending branch of the lateral circumflex femoral artery, were prelaminated with a fibula in the setting of salvage head and neck reconstruction. With a paucity of recipient vessels in the neck and a previous failed free fibula transfer secondary to osteoradionecrosis, a fibula was implanted into a suprafascial pocket created in the anterolateral thigh. This was allowed to pick up a blood supply from this rich vascular bed and - mature over a period of 3 weeks before being transferred with the - anterolateral thigh tissues as a prelaminated osteocutaneous composite free flap. A bone scan performed both before and after transfer confirmed uptake of - radionucleotide by the fibula suggesting neovascularization. The composite mandibular defect was successfully reconstructed using this technique, and we believe this could represent a new strategy in the setting of salvage head and neck surgery.