The anterior chest approach for obtaining free osteocutaneous rib grafts.

Fresh cadaver dissections indicated that the anterior chest approach for obtaining a free osteocutaneous rib graft, based on the anterior intercostal vessels, would be feasible. Following this, a mandibular defect in radiated tissue was successfully repaired in one stage by a free osteocutaneous graft with microvascular anastomoses. A 22-cm segment of rib, with overlying muscle and skin measuring 10 X 30 cm, was transferred. Follow-up, with selective arteriography at 6 months, confirmed the belief that the periosteal blood supply alone could support the rib segment. The anterior chest approach, to obtain a free osteocutaneous rib graft, is easier, faster, and safer than the posterior approach.