Free Composite Osteotomized Serratus Anterior Chondroosteomusculocutaneous Flap for Dynamic Reconstruction of a Pediatric Combined Maxillectomy and Hemimandibulectomy Defect: A Case Report
Microsurgery, cilt.46, sa.5, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 46 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.1002/micr.70249
- Dergi Adı: Microsurgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: composite defect, head and neck, pediatric maxillomandibular reconstruction, serratus anterior chondroosteomusculocutaneous flap
- İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet
Özet
Pediatric mandibular reconstruction is challenging due to the need to restore mandibular continuity, temporomandibular joint (TMJ) function, and long-term craniofacial growth. Conventional osseous free flaps may not adequately reproduce the ramus–condyle unit or provide a growth-capable cartilaginous component. The serratus anterior-rib composite flap offers vascularized bone and costochondral tissue but remains rarely used in children. We presented a 12-year-old pediatric patient with rhabdomyosarcoma who underwent en bloc resection including hemimandibulectomy and maxillectomy. Reconstruction was achieved using a free composite multi-segment osteotomized serratus anterior chondroosteomusculocutaneous flap incorporating the vascularized 6th rib, its costochondral junction, serratus anterior muscle, and a skin paddle. The rib was osteotomized to recreate mandibular contour, and the costochondral junction was shaped to form a neocondyle. The flap tolerated adjuvant radiotherapy and chemotherapy without complications over a 19-month follow-up period. No mandibular asymmetry was observed. Although larger series with longer follow-up periods are needed, this technique may offer a single-flap, growth-preserving solution for complex defects involving the ramus–condyle unit in pediatric patients.