The free vascularized anterior rib graft.

The free vascularized anterior rib graft, one of the earliest free osseous transfers to the head and neck, has not gained widespread acceptance, perhaps due to early reservations concerning the adequacy of the periosteal circulation. The authors present further laboratory evidence, with clinical cases, attesting to the adequacy of the periosteal circulation alone. Our surgical technique varies from other reports in that a substantially greater length of the internal mammary vessels is harvested and includes the dual periosteal supply by means of the supracostal and intercostal vessels, both branches of the internal mammary vessels. This modification is based on anatomic and angiographic findings. The incorporation of both branches enhances the margin of safety in raising this free bone graft.