Radial Forearm Free Flap for Microvascular Reconstruction of Post-COVID Mucormycosis Maxillary Defect: A Case Report

Abstract

Post-COVID mucormycosis has resulted in a significant increase in patients presenting with complex maxillary defects, necessitating exploration of effective reconstructive and rehabilitation strategies. This case report describes the microvascular reconstruction of an oroantral defect in a 52-year-old male following subtotal maxillectomy for rhino-maxillary mucormycosis. The patient initially underwent reconstruction using a patient-specific implant (PSI) to restore skeletal continuity; however, functional deficits persisted due to soft tissue deficiency. The defect measured approximately 8 × 4 cm and was subsequently reconstructed using a radial forearm free flap. The surgical procedure involved flap harvesting with a long vascular pedicle, followed by microvascular anastomosis to the facial vessels and precise intraoral inset to re-establish palatal integrity. Postoperative recovery was uneventful, with no evidence of flap compromise. At the three-month follow-up, the patient demonstrated complete resolution of nasal regurgitation, significant improvement in speech articulation, and restoration of mastication. This case highlights the limitations of PSI in addressing soft tissue defects and underscores the importance of microvascular reconstruction in achieving functional rehabilitation. Alternative rehabilitation options, including obturator prostheses, implant-supported prostheses, and regional flaps, should be considered based on defect size and patient factors. The radial forearm free flap remains a reliable and versatile option for restoring oral function and improving quality of life in patients with post-mucormycosis maxillary defects.