Uncommon Mandibular Reconstruction With Pedicled Osteomyocutaneous Latissimus Dorsi Flap: Case Experience and Scoping Literature Review.

BACKGROUND

The treatment of malignancies in the head and neck is challenging not only during primary tumor resection and reconstruction, but also in later settings, especially following complications and adjuvant therapies. Aiming to achieve the best possible outcome regarding oncological safety and function, the interdisciplinary team can be faced with difficult decisions. This article aimed to draw attention to the difficult decisions reconstructive head and neck surgeons face, as well as to the pedicled osteomyocutaneous latissimus dorsi (LD) flap with vascularized rib bone in particular as an unusual yet safe option to address these challenges in patients in whom free tissue transfers carry a high risk of failure or may not be available.

METHODS

This reconstructive option is further examined in a scoping review, following the PRISMA scoping literature review guidelines. MEDLINE via PubMed, Cochrane Library, and Embase were searched, applying a defined search strategy.

RESULTS

In our conducted scoping review, 2 case reports described mandibular reconstruction with pedicled osteomyocutaneous LD flap including vascularized rib bone. We share our experience with a patient with floor of the mouth squamous cell carcinoma undergoing multiple tumor resections and flap reconstructions, and experiencing a number of peri- and postoperative complications. The final reconstruction was performed with a pedicled osteomyocutaneous LD flap with rib bone.

CONCLUSIONS

The pedicled osteomyocutaneous LD flap with a vascularized rib, although not aesthetically comparable to results achievable with osseous free flaps, offers a safe reconstructive solution with a sizeable, vascularized bone segment, as well as reliable and extensive soft tissue coverage.