29/04/2026
A 70 year-old high risk patient, from Orissa, a known case of carcinoma right buccal mucosa, presented with pain and discharge from the operative site. He had previously undergone commando resection with PMMC flap reconstruction 5 months earlier. However, his course was complicated by PMMC flap necrosis, followed by a right nasolabial flap reconstruction, which also failed due to necrosis at an outside hospital.
Subsequently, the patient developed an orocutaneous fistula with mandibular osteomyelitis. PET-CT revealed a metabolically active lesion involving the mandible, along with features of infection and fistula formation.
Given the complexity of the case, the patient underwent salvage surgery, including segmental mandibulectomy (removal of the infected mandible), neck vessel preparation, and reconstruction using a left anterolateral thigh (ALT) free flap.
This case highlights the importance of timely salvage intervention in recurrent and complicated head & neck cancers, where advanced reconstructive techniques play a crucial role in restoring function, controlling disease, and improving patient outcomes.
