Contralateral facial artery-based chimeric flap for reconstruction of large oral cavity defects in elderly pre-frail patients: a two-case report

Background Large oral cavity defects after oncologic ablation require reliable reconstruction to restore oral function and aesthetics. Although free flap reconstruction remains a standard option, it may be unsuitable for elderly pre-frail patients with multiple comorbidities. This report describes a contralateral facial artery-based chimeric flap combining a nasolabial island flap and a submental artery island flap for reconstruction of large oral cavity defects. Case presentation Two elderly pre-frail patients with squamous cell carcinoma of the tongue and floor of the mouth underwent wide local excision, resulting in moderately large soft-tissue defects involving the tongue and floor of the mouth. The defects could not be adequately reconstructed using either a nasolabial island flap or a submental artery island flap alone. A contralateral facial artery-based chimeric flap was therefore designed to provide sufficient local tissue volume while avoiding microvascular anastomosis. All donor-site incisions were closed primarily, and no immediate donor-site wound complications occurred. At approximately 1 year of follow-up, both patients demonstrated acceptable oral intake and overall functional recovery; however, mild cheek depression, persistent partial facial paralysis in Case 2, and intraoral hair growth in the male patient were observed. Conclusions A contralateral facial artery-based chimeric flap composed of a nasolabial island flap and a submental artery island flap may be a useful reconstructive option for large oral cavity defects, particularly in elderly pre-frail patients who may be unsuitable candidates for free flap reconstruction.