A patient presented with non healing ulcer in the buccal mucosa. On biopsy it was diagnosed as Squamous cell carcinoma and was involving the GB sulcus, cheek and also the overlying skin. Decision to do a composite resection of the tumor along with hemimandibulectomy was done. Earlier at the time of planning the reconstruction, the loss of cheek skin was envisaged and a double paddled(bipaddle) pectorals major musculocutaneous flap was planned.
After the excision of the tumor the residual raw area is marked and the dimensions of the flap are marked. The pectorals major musculocutaneous flap with a long skin paddle was raised according to the standard technique with thin cuff of the muscle around the vascular pedicle of the flap. The flap is then tunneled through the subcutaneous space in to the defect. The intraoral part is inset first and the flap is turned to outside and flap is inset. The intervening segment at the angle of the mouth on the flap is deepithelialised and sutured to the angle of the mouth.
