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Background <p>Reconstruction of advanced buccal mucosa defects involving the infratemporal fossa (ITF) remains challenging because successful restoration requires not only mucosal lining and external skin cover but also effective obliteration of deep dead space. Failure of regional flaps in such defects can further complicate reconstruction, particularly in previously operated or infected necks.</p> Case Presentation <p>A diabetic patient with locally advanced squamous cell carcinoma of the left buccal mucosa underwent composite resection with posterior segmental mandibulectomy, infratemporal fossa clearance, and bilateral neck dissection. Primary reconstruction using a pectoralis major myocutaneous (PMMC) flap was complicated by deep-space infection caused by Morganella morganii and distal skin paddle necrosis, resulting in exposure of the infratemporal cavity. Salvage reconstruction was performed 10–12 days later using a chimeric anterolateral thigh (ALT) flap incorporating vastus lateralis muscle. Due to an infected and previously dissected ipsilateral neck, contralateral facial vessels were used as recipient vessels with 30-cm great saphenous vein graft-assisted pedicle extension. The muscle component obliterated the infratemporal dead space, while the skin paddle restored both intraoral lining and external cheek cover. Complete flap survival was achieved, and postoperative imaging at 3 months demonstrated no evidence of residual or recurrent disease.</p> Conclusion <p>This case demonstrates that PMMC flap failure does not preclude successful salvage reconstruction. A chimeric ALT flap with vascularized muscle and interposition vein grafts can provide reliable reconstruction of complex composite buccal defects, facilitate dead-space obliteration, and enable timely continuation of adjuvant oncologic treatment.</p>

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Free Anterolateral Thigh Flap for Salvage Reconstruction After PMMC Flap Failure in a Composite Buccal Defect

  • 期刊论文

  • 发表日期：

    2026年7月13日

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  • Radhika Kapahtia,
  • Karthik Rao,
  • Prajwal Dange,
  • Teertha Shetty,
  • B. S. Srinath

摘要

Background

Reconstruction of advanced buccal mucosa defects involving the infratemporal fossa (ITF) remains challenging because successful restoration requires not only mucosal lining and external skin cover but also effective obliteration of deep dead space. Failure of regional flaps in such defects can further complicate reconstruction, particularly in previously operated or infected necks.

Case Presentation

A diabetic patient with locally advanced squamous cell carcinoma of the left buccal mucosa underwent composite resection with posterior segmental mandibulectomy, infratemporal fossa clearance, and bilateral neck dissection. Primary reconstruction using a pectoralis major myocutaneous (PMMC) flap was complicated by deep-space infection caused by Morganella morganii and distal skin paddle necrosis, resulting in exposure of the infratemporal cavity. Salvage reconstruction was performed 10–12 days later using a chimeric anterolateral thigh (ALT) flap incorporating vastus lateralis muscle. Due to an infected and previously dissected ipsilateral neck, contralateral facial vessels were used as recipient vessels with 30-cm great saphenous vein graft-assisted pedicle extension. The muscle component obliterated the infratemporal dead space, while the skin paddle restored both intraoral lining and external cheek cover. Complete flap survival was achieved, and postoperative imaging at 3 months demonstrated no evidence of residual or recurrent disease.

Conclusion

This case demonstrates that PMMC flap failure does not preclude successful salvage reconstruction. A chimeric ALT flap with vascularized muscle and interposition vein grafts can provide reliable reconstruction of complex composite buccal defects, facilitate dead-space obliteration, and enable timely continuation of adjuvant oncologic treatment.