Original article © EUROMEDITERRANEAN BIOMEDICAL JOURNAL 2015, 10 (16):191-196. DOI: 10.3269/1970-5492.2015.10.16 Available on-line at: http://www.embj.org Address of the authors: 1 Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo, Palermo, Italy. 2 Plastic Surgery Unit. Sant'Andrea Hospital; "Sapienza" University of Rome, Rome, Italy. Send correspondence to: Francesca Toia, francescatoia@gmail.com Received: 3rd September, 2015 — Revised: 22th September, 2015 — Accepted: 30th September, 2015 ISSN 2279-7165 - Euromediterranean Biomedical Journal [online] E URO M EDITERRANEAN B IOMEDICAL J OURNAL for young doctors THE CHIMERIC ALT-VASTUS LATERALIS FREE FLAP IN RECONSTRUCTION OF ADVANCED BRONJ OF THE MAXILLA Francesca Toia 1 , Michele Cillino 1 , Salvatore D’Arpa 1 , Sara Di Lorenzo 1 , Fabio Santanelli di Pompeo 2 , Adriana Cordova 1 Summary Introduction Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a dangerous complication of bisphosphonates, a class of pharmaceutical agents used in numerous bone disor- ders. No gold standard therapy exists, but recent literature suggests that, in advanced stages, the best results are achieved with aggressive debridement. In this paper, we report our experience of treatment of stage 3 BRONJ of the maxilla with extensive surgical debridement and reconstruction with a chimeric ALT-Vastus lateralis flap. Methods Five selected patients with stage 3 BRONJ underwent partial maxillectomy with dis- ease-free margins followed by immediate reconstruction with a chimeric ALT-Vastus lateralis free flap. Results Only two patients experienced minor complications. All other patients healed unevent- fully within two weeks and donor site morbidity was minimal. Conclusions Our data suggest that aggressive debridement and reconstruction with a chimeric ALT -Vastus lateralis flap is an effective option for the treatment of stage III BRONJ of the maxilla. Introduction Bisphosphonate related osteonecrosis of the jaw (BRONJ) is defined as the presence of exposed bone in the oral cavity that does not regress within eight weeks in a pa- tient who is currently, or has previously been, treated with bisphosphonates and who has not had radiotherapy to the craniofacial region 1 .