Chimeric Lateral Supramalleolar Artery Perforator Fibula Free Flap in the Reconstruction of Composite Head and Neck Defects

Abstract

The authors evaluate the use of an osteomyocutaneous fibula free flap, combined in a chimeric fashion, with a lateral supramalleolar flap, in 10 patients with composite head and neck defects. All reconstructions were performed successfully. With the exception of one patient who died after disease recurrence, all patients were decannulated and resumed an oral diet. Speech intelligibility was good in seven of 10 patients. Dental implants were used in two of 10 patients, with a total of 10 fixtures placed successfully. The donor site healed without complications in all except one case, where necrosis of the skin graft occurred with fungal infection. The chimeric lateral supramalleolar artery perforator fibula free flap may be a valid option for maximizing the quality of life in patients with composite oromandibular defects.

Chimeric vs composite flaps for mandible reconstruction

“…Other authors have advocated for the use of the intrinsic chimeric flap in complex mandible reconstruction, although they may not specifically use the term. [12][13][14][15][16][17][18][19] One prior study reviewed a groups' experience with chimeric fibula flaps for orofacial reconstruction and showed no significant difference in flap loss rates between the 12 chimeric and 22 composite flaps for orofacial reconstruction; however, they did not investigate other complications or analyze differences in the defect types reconstructed with the different flap types. 20 Despite the advantages of the intrinsic chimeric flap, there do still remain some scenarios in which 2 free flaps may be necessary.…”

Colgajos Microvascularizados en Reconstrucción Maxilofacial: Avances de la Microcirugía

“…5), con excelentes resultados en mandíbula en defectos mandibulares, de mucosa oral, farínge, piel y en defectos de lengua moderados, la desventaja es que entrega una capa cutánea sin gran cantidad de tejido blando, por lo que en defectos de lengua de mayor extensión no son útiles. Esta zona posee ciertas variantes anatómicas en sus vasos, por lo que debe tenerse esa precaución al momento de disecar y planificar el colgajo geométrico (Massarelli et al, 2014). Otro colga-jo es el dependiente de la arteria subescapular, con buenos resultados en zona de la maxila, con la desventaja de vasos de menor calibre y menor largo del pedículo en comparación a otros colgajos como el de fíbula, pero es una buena opción para reconstrucción de la maxila (Watanabe et al).…”

Perioperative pain management after fibular free flap harvesting for head‐and‐neck reconstruction using mini‐catheters to inject local anesthetic: A pilot study

“…Reconstruction of head‐and‐neck defects extending to the maxilla and mandible routinely features the placement of bone‐containing free flaps (Bianchi et al, ; Urken et al, ). Of the different donor site options available when composite flaps are required, the fibula, iliac crest, and scapula are the most commonly used worldwide, with a fibular free flap being the first option in most cases (Massarelli, Gobbi, Biglio, Soma, & Tullio, ; Okay et al, ; Van Genechten & Batstone, ). The advantages of this flap in terms of reconstruction are well‐known; many papers on this topic have been published over the past 30 years (Aydin, Emekli, Erer, & Hafiz, ; Moubayed et al, ).…”