Chimeric flap in clinical use

Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects

“…Koshima et al 29,30 introduced the ''chimeric flap'' concepts by using more than two different flaps anastomosed to the same pedicle with flow-through technique. 24 The major advantage of the chimeric flap is the independent mobility of skin, muscle, and bone as a single-unit tissue transfer. These various components of the chimeric flap facilitate three-dimensional reconstruction in the head and neck region.…”

“…These various components of the chimeric flap facilitate three-dimensional reconstruction in the head and neck region. 24,[29][30][31] However, the chimeric flap technique requires two pairs of microsurgical anastomoses and two donor sites (anterolateral thigh flap and vascularized muscle or bone graft). 29,30 Our osteomyocutaneous PAP flap includes several different tissue components from one donor site as a composite flap that is nourished by the same pedicle without additional flowthrough anastomosis.…”

“…The mobility of the standard osteocutaneous fibula flap skin paddle is usually restricted because of its broad attachment to the posterolateral intermuscular septum. 24 A larger skin paddle in the conventional fibula osteocutaneous flap with deepithelialization and folding may compromise the distal skin circulation. Two separate skin paddles of the osteomyocutaneous PAP flap may accommodate in a 90-degree direction between the palatal and nasal mucosa defect.…”

“…These myocutaneous perforators piercing into the deep fascia, between the peroneus longus and soleus muscles, nourish the lateral part of soleus muscle. 23,24 A segment of soleus muscle was harvested FIGURE 1. A 42-year-old woman with low-grade myofibroblastic sarcoma on the left maxillary sinus underwent a subtotal maxillectomy, which included defects of the maxilla, maxillary sinus, nasal, and palatal mucosa (case 2).…”

The anatomical investigation for harvesting various chimeric flaps based on the peroneal artery

“…[4][5][6][7] However, when defects are extensive, complex and three-dimensional in nature, the conventional fibular composite flap whose various components, being interdependent on each other for vascularization and survival, are unable to be separated, is not maneuverable enough to inset to cover the defects as described above. 8 Meanwhile, when the ends of a bone defect are not well vascularized, modification should be made to the conventional composite fibular flap to include excessive vascularized periosteum which can be wrapped around the graft-and host contact so that bone union can be enhanced by the osteogenic and angiogenic property of the periosteum. Consequently, in this paper, we presented an in-depth anatomical study into the peroneal vascular system, providing the anatomical basis for harvest various peroneal artery-based chimeric composite flaps for repair of compound tissue defects with complex geometric distribution.…”