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Reconstruction of composite oromandibular defects of oral malignancy is a challenging problem for oromaxillofacial and plastic surgeons. Revolutionary microvascular surgical techniques permit surgeons to use two free flaps in one stage— one for the bone and inner lining and one for the skin or soft tissue. But in some cases with poor quality of recipient vessel site and heavily irradiated neck condition, these flaps also have some problems, especially in ablative surgical cases with large soft-tissue loss. The aim of this article was to report a case of reconstruction of composite oromandibular defects with a rib-major pectoralis myocutaneous flap carrying costal parietal pleura. Case report In this article, a rib-major pectoralis myocutaneous flap was used to reconstruct a composite oromandibular defect with excellent cosmetic and functional outcome. It provided a suitable and costeffective reconstruction with low microsurgical risk, relatively short operative time, sufficient softtissue replacement and minimum donor site morbidity. Conclusion This reconstructive method of the compound osteomyocutaneous flap should not be forgotten when two free flaps in one reconstructive stage are gaining in popularity.

Reconstruction of composite oromandibular defects with rib-major pectoralis myocutaneous flap carrying costal parietal pleura: a forgotten option?