The folded, bipaddled pectoralis major composite flap in oral cancer reconstruction.

We report on the pectoralis major composite (musculocutaneous or rib osteomusculocutaneous) flap used in bipaddled fashion for one-stage immediate reconstruction in 53 patients with oral cancer. Of these, 44 patients had lesions of buccal mucosa and lateral lower alveolus, and 9 patients had lesions of floor of mouth and middle third of lower alveolus. In one patient this flap was used as a free composite tissue transfer in bipaddled fashion. The flap can be used either before or after radiotherapy in oral cancer and provides both lining mucosa and skin cover. If necessary, a rib (vascularised bone graft) incorporated with this composite flap can give skeletal support for mandibular arch reconstruction.