**1. Introduction**

Effective reconstruction following ablative surgery of maxillomandibular defects requires the provision for adequate oral lining, skin, and replacement of missing bone; in some situations, restitution of function of the temporomandibular joint also requires reconstruction-preferably achieved in one stage. Conventional replacement of bone defects usually involves the use of autogenous cancellous bone grafts from either the iliac crest or ribs after provision of adequate skin cover by pedicled axial-pattern skin flaps such as a pectoralis major flap.[1]

Early reconstructive efforts with nonvascularized bone grafts were plagued by a high inci‐ dence of postoperative complications and poor long-term outcomes. [2] Inadequate local blood supply due to poorly vascularized flaps or irradiation resulted in rapid resorption of the grafts. The advent of techniques in which composite flaps containing skin and bone together with their own independent blood supply transferred either as pedicled osteocutaneous flaps or free osteocutaneous flaps has revolutionized the concepts of head and neck reconstruction.[1] Early postoperative complications decreased even in the setting of postoperative radiation; and expectations for successful oral rehabilitation, including placement of osseointegrated implants, rose markedly.[2]

#### **1.1. History**

The first vascular anastomosis was introduced by J.B. Murphy in 1892; and Alexis Carrel made an end to end anastomosis by using a three-stay suture technique. [3] The first anastomosis in a dog was performed by Krizek. [4] Following him, the first free flap was published in 1971. [3]

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