Reconstruction fo Through and Through Defect of the Cheek with Combined Flaps in Buccal Mucosa Cancer

Large lateral facial defects especially through and through defect of the cheek remain reconstructive challenge to the head and neck surgeon. Closure of these wounds is problematic due to the magnitude and location of the soft-tissue and skin defect, functional and aesthetic consideration, optimal cancer surveillance, and desire for good nourishment. Traditional methods of dealing with these defects, including split-thickness skin graft, local flaps, regional flaps as well as musculocutaneous flaps, have their limitations. We applied two combined flaps for these reconstruction in two cases. We used temporal muscle flap and forearm free flap for mucosal repair, and medial base cervicopectoral flap and pectoralis major myocutaneous flap for external skin reconstruction. Forearm free flap was superior to the temporal flap because of its robust nature in buccal reconstruction. For external repair, cervicopectoral flap was superior to the pectoralis flap in color match. So we suggest forearm free flap for internal repair and cervicopectoral flap for external repair for this troublesome repair.ope