A systematic approach to patient safety and surgical education during a surgical mission in a resource-limited setting: A case report of double free flap reconstruction for a lower facial defect

Reconstruction of complex mandibular and lower facial defects poses significant challenges, especially in resource-limited settings. Double free flap reconstruction offers tailored tissue replacement when single-flap options are inadequate. We report the case of a 25-year-old male with a large composite mandibular and oral floor defect following a failed pedicled flap reconstruction after gunshot trauma. A structured checklist was used for planning and executing a safe and educational microsurgical procedure in a resource-limited setting. The patient underwent successful reconstruction using a chimeric osteocutaneous free fibula flap for mandibular framework and oral lining, combined with a free anterolateral thigh flap for external soft tissue and lower lip reconstruction, including a tensor fascia lata sling for lip suspension. Complex double free flap reconstruction can be safely achieved in low-resource environments through meticulous planning, multidisciplinary teamwork, and adaptation to available resources, providing functional and aesthetic outcomes. The presented checklist provides a practical framework for planning similar cases that balances patient safety with surgical education.