Free composite osteotomized serratus anterior chondroosteomusculocutaneous flap for dynamic reconstruction of a pediatric combined maxillectomy and hemimandibulectomy defect: a case report

Abstract

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.