Simultaneous left maxillary and right mandibular reconstructions with a split osteomyocutaneous peroneal artery-based combined flap

Background Traditionally, reconstruction of concurrent maxillary and mandibular defects on opposite sides of the facial skeleton often requires use of 2 free osseocutaneous flaps. A new technique of using a differentially split osteomyocutaneous peroneal artery-based combined (OPAC) flap for 1-stage reconstruction of left maxillary and right mandibular defects is presented. Methods An OPAC flap with 1 skin paddle and a cuff of soleus muscle was harvested. The fibula was split; the distal osseous flap was used for right mandibular reconstruction, and the proximal OPAC flap composing of proximal fibula, skin paddle, and soleus muscle was used for the maxillary reconstruction. Bilateral facial vessels were used as recipient vessels. Results No complications were encountered. The patient showed good functional and cosmetic outcomes at 1-year follow-up. Conclusion The split OPAC flap allows for simultaneous reconstruction of bony defects that are spatially far apart without the need for a second free flap.