A salvage surgery case of mandibular reconstruction with serratus anterior muscle flap with pedicled rib graft having good clinical course in long-term observation

Abstract

One-stage reconstruction after segmental mandibular resection typically involves using a vascularized bone graft due to the widespread development of free-tissue transfer techniques. The choice of reconstruction method is influenced by the length and location of the mandibular defect and the patient’s age, underlying conditions, and overall physical state. Currently, fibular or iliac bone flaps are often chosen because they can allow for a sufficient length of bone to be harvested and ensure the reproducibility of the natural mandible shape. Conversely, scapular and rib flaps, which require patient repositioning, are less preferred because of existing concerns regarding their strength and consistency with the mandible’s shape. In addition, mandibular reconstruction using a reconstruction plate can result in postoperative complications such as plate infection and fracture, in some patients. These complications often require plate removal and additional reconstructive surgery. Herein, we present the case of a 73-year-old man who underwent segmental mandibulectomy and plate reconstruction for a right mandibular gingival malignancy. Fifty-four months later, a fracture of the reconstructed plate was observed. We report the treatment experience of performing rib flap re-reconstruction as a salvage procedure for a fractured reconstruction plate. Although this approach was necessitated by the difficulty of using the healthy lower limb under the absence of the right lower limb, resulting in a stable long-term outcome.