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 FIG. 14-21. The long radial vessel pedicle was anastomosed to the anterior facial vessels well away from the area of radiation injury. The radial artery was repaired with a reversed vein graft.
 FIG. 14-22. Postoperatively, the contour of the flap was good. There was still a slight color mismatch, but it was better than the skin graft. Oblique view.
 FIG. 14-23. Front view.
CASE 4
A 67-year-old man had squamous cell carcinoma of the floor of his mouth resected and treated by radiotherapy.
 FIG. 14-24. The patient developed osteoradionecrosis of the mandible on the right side, with nothing to see externally.
 FIG. 14-25. Intraorally, there was exposed bone. The right intraoral sulcus is shown (tongue to the right).
 FIG. 14-26. With the cheek flap elevated, one can see the extent of radionecrotic mandible.
 FIG. 14-27. The dead mandible was resected and an osteocutaneous radial forearm flap planned for reconstruction. External skin cover was good, but oral lining was needed. The bony defect was easily bridged by bone from the radius. It was fixed with AO screws into notches in the outer cortex of the mandible.
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 FIG. 14-28. Outline of forearm flap and bone segment.
 FIG. 14-29. Postoperatively, the mandibular contour is the lateral cortex of the radius is
fairly good.
 FIG. 14-30. The cutaneous paddle is seen intraorally overlying the reconstructed
mandible.
 FIG. 14-31. The patient is able to wear dentures without problems, and the flap has been durable.
 FIG. 14-32. The flap donor site is acceptable, but a hollow can be seen where the lateral cortex of the radius is absent.
CASE 5
A 35-year-old man was treated surgically for a lesion on the anterior floor of the mouth, resulting in a defect.
 FIG. 14-33. The tongue has been reflected superiorly, and the cheek flaps reflected laterally. The upper lip is visible just above the teeth (upper right). The anterior mandible and a significant portion of the body of the left side of the mandible were missing.
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