Objective:The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems.Materials and Methods:A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied. While majority of the skin paddles received their blood supply from the peroneal septocutaneous perforators, a few had their dominant supply from the soleus musculocutaneous perforators in addition to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous perforators were the sole source of blood supply to the skin paddle. The limitation in this study was the inability to augment the clinical observation with cadaveric study.Results:The skin paddle of the free fibula flap was classified into four different types (a–d) based on the dominance of vascular contribution by axial vessels of the leg.Conclusion:The skin paddle of the free fibula flap has reliable blood supply, but a thorough knowledge of the variations in vascular pattern of the skin paddle is required especially to salvage the larger paddles used in the reconstruction complex oro-mandibular defects.
The proximally based sural artery flap presents distinct advantages in reconstruction of knee and lower thigh defects including thin sensate flap, reduced donor-site morbidity with good aesthetic outcome. However there are few reports in the literature regarding this flap. This study presents our experience with use of this flap in 37 patients. A retrospective study was performed over a 6-year period (from January 2003 to October 2008) using proximally based islanded sural artery flap for the lower thigh, knee, and upper leg defects following tumor excision defects. There were no complete failures in the series with only one flap requiring additional bipedicled flap for the necrosis of distal margin. All donor sites were closed with split thickness skin graft, with skin paddle sizes ranging up to 23 x 10.5 cm. All patients achieved a good final outcome. The authors found the proximally based islanded sural artery flap to be a simple and reproducible technique to perform and have greater reach up to the lower thigh. It provides thin pliable skin with minimal compromise to either appearance or function. The flap is suitable in the regional reconstruction around the knee as a pedicled flap.
Reconstruction of extensive oncosurgical defects of lower trunk, perineum and upper thigh, without the complexity of microsurgery, is a reconstructive challenge. Pedicled anterolateral thigh (ALT) flap offers many advantages over other regional flaps for this purpose, such as the large skin and soft tissue availability, the remarkable pedicle length and the reliability. However, there is paucity of literature describing the utility of pedicled ALT flaps for reconstruction of these difficult soft tissue defects. We present our experience of pedicled ALT flaps for various post oncosurgical defects. From January 2005 to August 2008, 85 pedicled ALT flaps were done in 78 patients for post oncological excision defects of lower trunk, groin, perineum, and upper thigh. Majority of patients were males, with locally advanced inguinal disease, underwent wide skin excision and en bloc nodal resection. Age group ranged from 22 to 81 years. The flap size ranged from 10 x 5 cm (50 cm) to 38 x 20 cm (760 cm). The length of the pedicle ranged from 8 to 14 cm. Satisfactory coverage was achieved in all patients, except one, where the flap had to be discarded due to absent artery in the vascular pedicle. Clinically, no functional deficit of knee extensor mechanism was seen in any of these patients during routine activities. Present study has shown the wide arc of rotation, large skin replacement potential, and reliability of pedicled ALT flap.
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