Primary reconstruction of head and neck cancer with anterior rib, osteomyocutaneous composite flap

The anterior rib, osteomyocutaneous composite flap (AROCF) incorporating both vessels, supracostal and intercostal, has been harvested for primary reconstruction in advanced head and neck cancer patients. The adequacy of the periosteal circulation alone for the successful free osseous transfer has been well proved. The available length of the internal mammary vessels is sufficient for the successful microvascular anastomosis in the neck. This same AROCF can be used as a pedicled flap based on the pectoralis major musculo-vascular pedicle for successful primary reconstruction in cases in which it is deemed unsuitable for use as a free flap. This is possible because of the unique functional blood supply of the rib.