Composite pedicled rib flap for reconstruction of the mandible and face.

A new technique of bony and soft tissue augmentation to the mandible, face, and neck is presented. It consists of a composite soft tissue flap from the anterior chest, including two ribs attached and transposed without delay to the newly prepared tissue bed. The distal portion of this flap is de-epithelialized for soft tissue augmentation to the face. The ribs are wired to the mandible, and the flap is released in six to eight weeks. At that time, the proximal segment is de-epithelialized for further augmentation. The soft tissue mass is supported against gravity for three to four months with a chin strap. It is desirable to use this concept as a secondary procedure rather than associating it with the primary ablative technique. One can expect significant improvement in esthetics and contour from this technique.