Flow-Through Flap for Salvage of Fibula Osseocutaneous Vascular Variations: A Surgical Approach and Proposed Modification of Its Classification

Parr, Justin M.; Adams, Brandon; Wagels, Michael

doi:10.1016/j.joms.2013.12.011

Cited by 15 publications

(12 citation statements)

References 8 publications

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“…Parr et al harvested two independent flaps in the same situation for reconstruction of the mandible. 5 The peroneal vessels supplying the fibula flap were anastomosed to the recipient vessels, and the perforator vessels supplying the skin flap were anastomosed end-to-end to the distal ends of the peroneal vessels. Nakazawa et al reported the same variant perforator in the reconstruction of the lower leg.…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge, five authors have described a rare variant where the fibula was supplied by the peroneal artery, and the overlying skin paddle was supplied by the perforators originating from the posterior tibial artery. [2][3][4][5][6] In such rare situations, the fibula and skin flaps would have to be revascularized separately and the skin paddle cannot serve as a monitor for the fibula. We present a rare variant encountered while elevating an osteocutaneous fibula flap Keywords ► osteocutaneous fibula flap ► variant perforator ► lower leg reconstruction…”

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confidence: 99%

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Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction

Kawamura

Omokawa

Shimizu

et al. 2017

J Reconstr Microsurg Open

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The vascularized free osteocutaneous fibula flap has become a universal technique for reconstruction of bone and soft tissue defects in the lower leg since Taylor et al first described it in 1975. 1 The fibula and overlying skin paddle are usually nourished by a single pedicle composed of the peroneal artery and comitant veins. However, to the best of our knowledge, five authors have described a rare variant where the fibula was supplied by the peroneal artery, and the overlying skin paddle was supplied by the perforators originating from the posterior tibial artery. [2][3][4][5][6] In such rare situations, the fibula and skin flaps would have to be revascularized separately and the skin paddle cannot serve as a monitor for the fibula. We present a rare variant encountered while elevating an osteocutaneous fibula flap Keywords ► osteocutaneous fibula flap ► variant perforator ► lower leg reconstruction AbstractBackground The osteocutaneous fibula flap is an established method for reconstruction of bone and soft tissue defects in the lower extremity. The vascularity of the fibula and overlying skin paddle is usually provided by a single pedicle composed of the peroneal artery. In rare situations, the fibula is supplied by the peroneal artery, whereas the overlying skin paddle is supplied by perforators originating from the posterior tibial artery.Case Report A 28-year-old man presented with osteomyelitis of the tibia that was scheduled to be treated with a free vascularized osteocutaneous fibula flap from the contralateral lower leg. Intraoperatively, it was found that perforators supplying the skin paddle originated not from the peroneal artery but from the posterior tibial artery. A fibula flap nourished by the peroneal vessels was harvested and the skin paddle was returned to the lower leg. The fibula was fixed at the recipient site, and peroneal vessels were anastomosed to the recipient posterior tibial vessels. The skin defect was successfully managed with a perforator-based propeller flap nourished by the recipient artery.Conclusion To the best of our knowledge, only five authors have reported this variant vascularity of the osteocutaneous fibula flap. They harvested two independent flaps, one a skin flap and the other a fibula flap, and performed two separate vascular anastomoses at the recipient site. In comparison to previously reported cases, the salvage procedure using a perforator-based propeller flap is easy and reliable because there is no need for additional anastomosis of the perforator vessels.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction

Kawamura

Omokawa

Shimizu

et al. 2017

J Reconstr Microsurg Open

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“…The processes underlying the survival remain controversial, however there are several hypotheses. Anastomosing the two extremities of the artery creates a channel, which helps to facilitate venous drainage from the grafting flap, relieving much of the hydrostatic pressure of the area; the perforating veins, which forms in the early stage of grafting, combine with the capillary network, which forms in the late stage, to create blood circulation between the donor and recipient areas, resulting in the drainage of venous blood from the grafting flap; the bone marrow cavity beneath the graft provided a venous channel, which helps to drain the majority of the venous blood from the flap (7,9,29,30). Thoracic negative pressure induced when a respiratory pump is used, and the inherent venous pressure of the flap may also be important forces that drive the return of venous blood (22).…”

Section: A D C B E Discussionmentioning

confidence: 99%

“…The use of a flow-through compound radial artery forearm flap in reconstruction of the extremities was reported in 1984 (6). This operative technology was adopted to recover the integrity of the grafting trunk vessel by anastomosing its two extremities; the surgery not only reconstructs the defects, but also increases the blood supply to the distal limbs, especially for patients with only one remaining trunk vessel (7)(8)(9). Patients suffering soft tissue defects combined with tendon or bone exposure are required to undergo several surgical procedures, causing severe damage to the majority of the trunk veins.…”

Section: Introductionmentioning

confidence: 99%

Effects of preserving different veins on flow-through flap survival: An experimental study

Song

2015

Experimental and Therapeutic Medicine

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Abstract. Flow-through skin flap grafting is becoming widely used for the reconstruction of skin and soft tissue defects, particularly for patients with poor blood supply around the defect. However, the treatment of the veins remains controversial. In the present study, 5x2-cm skin flaps were created on the left inner thighs of rabbits in order to investigate the effects of various treatments of the veins on the survival of a flow-through skin flap. A femoral artery perforator running through the flap was preserved. Five groups were established in which no veins, one superficial vein (SV), one accompanying vein (AV), one SV plus one AV, or all trunk veins (control) were retained. The percentage of flap area survival was determined on day 10. On days 3, 5, 7 and 9, tissues were harvested from the skin flaps and immunohistochemical analysis was performed in order to count the number of microvessels. Western blot analysis was subsequently completed in order to determine the expression levels of vascular endothelial growth factor (VEGF). The flap areas in which no veins were retained demonstrated significantly reduced survival rates on day 10, as compared with those in the other four groups (P<0.01). Furthermore, flaps with the retention of a SV also demonstrated reduced survival rates, as compared with the AV, AV plus SV and all veins groups (P<0.01); however, there no significant differences were detected between the latter three groups (P>0.05). Immunohistochemical analysis on day 3 detected a greater number of microvessels in the flaps of the control group, as compared with the flaps of the other groups. Furthermore, the AV and AV plus SV groups demonstrated a greater number of microvessels, as compared with the SV and no vein groups, and he no vein group demonstrated the fewest microvessels. No significant differences were found between the AV, AV plus SV and control groups on day 5, 7 and 9. Western blot analysis on day 5 demonstrated that the expression levles of VEGF were significantly increased in the flaps of the AV, AV plus SV and control groups, as compared with those in the SV and no vein groups. No significant differences were detected between the former three groups, and increased VEGF expression levels were detected in the flaps of the SV group, as compared with the no vein group. The flow-through flap grafts with no retained veins barely survived. Anastomosing one AV was adequate for flap survival; however, further studies are required in order to investigate the survival of flow-through flaps in more detail.

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“…Its most usual presentation is in the posterior mandibular sector. The most common age of presentation is the third decade of life, being less frequent in children and over 50 [1][2][3][4][5][6][7][8][9][10][11]. It is a slow-growing tumor that can reach a considerable size many times without producing any symptomatology.…”

Section: Introductionmentioning

confidence: 99%

Mandibular Myxoma

Radzinski¹

2017

JDHODT

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The mandibular odontogenic myxoma is a tumor of mesenchymal origin. Represents 0.5 to 17.7 per cent of odontogenic tumors in different series and the 3rd in frecuency. It is a histologically benign but locally aggressive and prone to tumor recurrence, which determines treatment. We report 2 cases one case is a 33 years patient and the second one is 60 years patient both diagnosed with mandibular myxoma surgically treated with segmental mandibulectomy with safety margins and immediately reconstruction with titanium plate 2.0 and 2.4. Keywords: Odontogenic myxoma; Mandibular reconstruction

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Flow-Through Flap for Salvage of Fibula Osseocutaneous Vascular Variations: A Surgical Approach and Proposed Modification of Its Classification

Cited by 15 publications

References 8 publications

Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction

Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction

Effects of preserving different veins on flow-through flap survival: An experimental study

Mandibular Myxoma

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