Designing a Fibular Flow-Through Flap with a Proximal Peroneal Perforator-Free Flap for Maxillary Reconstruction

Abstract

Summary:Reconstruction of a composite maxillary defect is frequently performed with a fibular osteocutaneous free flap to address both the bony and mucosal defect. If during the harvest of the fibula a distal skin perforator is not present due to vascular variations, reconstruction can potentially be done using the soleus muscle for filling of the palatal mucosal defect. An additional challenge arises when the accompanying skin paddle that has been harvested is not perfused, but the fibula remains viable. This case report describes salvage following loss of the skin paddle in an osteocutaneous fibular free flap by designing a fibular flow-through flap using a proximal peroneal perforator free flap. The use of this second free flap allows a skin paddle to be positioned on the distal fibular segment, provides a surgical backup, and limits the donor sites to the same extremity.

The Vascular Supply to the Lateral Compartment of the Leg with Emphasis on Fibular Graft Harvesting

“…On the basis of our observations, and in line with Villareal et al, the risk of necrosis should be less in the proximal and middle thirds of the leg because the bular muscles are supplied by the ATA. (14,15,30,31). In the present study, the most distal and most proximal pedicles to the FB were 7.9 cm and 16.39 cm proximal to the lateral malleolus.…”

Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck

“…This has been successfully demonstrated in head and neck reconstruction using radial forearm, anterolateral thigh, and fibula free flaps (FFFs). [37][38][39][40] Specific challenges of using a flow-through flap as a recipient vessel are related to vessel geometry, smaller vessel caliber at the distal flap pedicle, and potential loss of both flaps if vessel clot propagates into the proximal pedicle.…”