One-stage reconstruction using a fibula osteocutaneous free flap and an anterolateral thigh free flap for an extensive composite defect - A CARE-compliant case report

Sep 24, 2026

Rationale: Regional lymph-node metastasis is common in advanced oral cancer, while extensive local invasion into structures like the mandible, neck skin/soft tissue, and masticator space is relatively rare. Surgical resection is usually most effective, though some patients cannot undergo it. Patient concerns: Two men aged 66 and 65 presented with large, multiple floor-of-mouth and bilateral neck masses. Diagnosis confirmed squamous cell carcinoma on biopsy. Interventions used fibula osteocutaneous free flap with titanium plate lining, 3D-printed mandibular reconstruction, and an ALT flap for anterior neck resurfacing. Outcomes showed successful single-stage reconstruction with excellent functional and aesthetic results and no recurrence. Lessons: Single-stage repair can restore oral mucosa, mandibular, and neck soft-tissue defects after mouth-floor cancer resection.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Rationale

Patient concerns

Diagnosis

Interventions

Outcomes

Lessons

Introduction

Epidemiology of mouth floor cancer

Patterns and challenges of invasion and metastasis

® Clinical Case Report One-stage reconstruction using a fibula osteocutaneous free flap and an anterolateral thigh free flap for an extensive composite defect after en bloc resection of squamous cell carcinoma on the mouth floor, mandible, and anterior neck A CARE-compliant case report SeHo Shin, MDa , KiHyun Kim, MDa , SangSeok Woo, MDa , KyungMin Kim, MDa , JunWon Lee, MDa , SeongHwan Kim, MD, PhDa , JaiKoo Choi, MD, PhDa , DongJin Lee, MD, PhDb , InSuck Suh, MD, PhDa,* | Abstract
Rationale: Although regional metastasis to the lymph nodes is common in advanced oral cancer, extensive local invasion into surrounding structures such as the mandible, skin and soft tissue of the neck, and masticator space is relatively rare. Sometimes surgical treatment cannot be performed and only palliative chemotherapy and radiation therapy are offered to preserve the quality of life of patients with advanced oral cancer. Nevertheless, the surgical resection of tumors remains the most effective treatment. This study presents a case of aggressive mouth floor cancer in which extensive composite defects on the mouth floor, oral mucosa, mandible, skin and soft tissue of the neck caused by tumor resection were reconstructed.
Patient concerns: A 66-year-old man and a 65-year-old man with no significant personal or family history visited our clinic due to a large and multiple masses on the floor of the mouth and both sides of the neck.
Diagnosis: Histopathological evaluation of the biopsy specimen revealed squamous cell carcinoma.
Interventions: A fibula osteocutaneous free flap and customized titanium plate were used for the intraoral lining. Mandibular reconstruction was performed using a 3D-printed bone model, and an anterolateral thigh free flap was used to resurface the anterior of the neck.
Outcomes: Reconstruction using this method was successful, and excellent functional and aesthetic outcomes were achieved without cancer recurrence.
Lessons: This study show that the reconstruction of extensive composite defects of the oral mucosa, mandible, and neck soft tissue following surgical resection of mouth floor cancer can be performed in a single-stage operation. Through a single-stage reconstruction, both excellent functional aspects without cancer recurrence and satisfactory aesthetic outcomes can be obtained. Abbreviations: 3D = three-dimensional, ALT = anterolateral thigh, CT = computed tomography, HNC = head and neck cancer, MRND = modified radical neck dissection, SCC = squamous cell carcinoma. | | --- | | Keywords: mandibular reconstruction, mouth floors, three-dimensional printings | Informed consent was obtained from the patient and the patient’s legal guardian for publication of this case report details. The authors have no funding and conflicts of interest to disclose. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. a Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea, b Department of Otorhinolaryngology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea. *Correspondence: InSuck Suh, Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea (e-mail: sismdps@hallym. [or.kr](or.kr)). Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided

FAQs

What was the patient presentation and main concern in this case report?

Two men presented with a large, multiple-floor-of-mouth mass and bilateral neck masses causing major composite defects after tumor resection considerations.

How was the diagnosis established?

Histopathological evaluation of the biopsy specimen showed squamous cell carcinoma.

What reconstruction strategy achieved both functional and aesthetic outcomes?

A one-stage approach combined a fibula osteocutaneous free flap with titanium plate for intraoral lining, 3D-printed mandibular reconstruction, and an anterolateral thigh free flap to resurface the anterior neck, with successful outcomes and no recurrence.

Sep 24, 2026

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