Free Fibula Osteocutaneous Flap With Soleus Muscle as a Chimeric Flap for Reconstructing Mandibular Segmental Defect After Oral Cancer Ablation

Abstract

In some cases, the fibula osteocutaneous flap may not provide sufficient soft tissue for obliterating dead space after tumor ablation. This report describes a modified fibula osteocutaneous flap using a portion of soleus muscle to reduce postoperative complications. This study analyzed 20 patients who underwent ablative oral cancer surgery with mandibular segmental defect between September 2005 and June 2007. Of total, 17 cases were mandible complex defects and 3 were composite defects. Of total, 18 were men and 2 were women, respectively. Age range was 30 to 74 years, and mean age was 53 years. The procedure entailed harvest of chimeric fibula flap with skin paddle and bone segment composed of a sheet of soleus muscle (7 x 4 to 12 x 5 cm in size) originating from the perforator branch of the peroneal artery. The soleus muscle was used to obliterate the dead space of the mouth floor and cheek-neck area. All flaps survived except 1 failure due to venous insufficiency. The submandibular and chin area exhibited mild swelling at the submandibular area early postoperatively. Patients had achieved satisfactory contour without donor site morbidity at a mean 12-months of follow-up. Complications included 2 flaps requiring reoperation due to the flap pedicle compromised. One flap was successfully salvaged but the other failed. Two cases of orocutaneous fistula-induced infection recovered after conservative treatment. Donor site assessment revealed a satisfactory outcome without major donor site morbidity. This refinement in mandibular reconstructive surgery substantially reduces postoperative complications.

Functional assessment of donor‐site morbidity after harvest of a fibula chimeric flap with a sheet of soleus muscle for mandibular composite defect reconstruction

“…Our previous study showed that a chimeric fibula osteocutaneous flap with a sheet of soleus muscle could provide more volume to successfully obliterate the neck and cheek dead space and improve coverage of the fibula bone and reconstruction plate. 12 All patients who received a fibula chimeric flap were satisfied with their facial aesthetic reconstruction and did not experience major complications after the operation.…”

“…In the chimeric group, the patients underwent the modified procedure for harvesting the fibula flap, as proposed by Yazar et al and described in our previous reports. 10,12 Harvest of the modified fibula flap involved complete harvesting of the osteoseptocutaneous flap together with a sheet of soleus muscle to create a chimeric flap. 12 The harvested chimeric fibula flap with skin paddle was centered at the posterior border of the fibula and the junction between the middle and lower thirds of the lower leg.…”

“…10,12 Harvest of the modified fibula flap involved complete harvesting of the osteoseptocutaneous flap together with a sheet of soleus muscle to create a chimeric flap. 12 The harvested chimeric fibula flap with skin paddle was centered at the posterior border of the fibula and the junction between the middle and lower thirds of the lower leg. A segment of soleus muscle was harvested from the separate musculocutaneous perforator originating from the main source of peroneal vessels.…”

“…This fibula chimeric flap not only obliterated the dead space, thus preventing infection, but also prevented postoperative radiotherapy-induced complications. 12 Nevertheless, the soleus muscle is one of the main components of calf muscles. Sacrificing a sheet of the soleus muscle may therefore adversely affect ankle function.…”

Minimally Invasive Subpericranial Model: Can It Be Used to Study Bone Substitutes?

“…Although synthetic bone fillers offer a potential alternative to autogenous bone grafts, extensive efforts to develop an ideal alloplastic bone substitute have so far been unsuccessful [1][2][3][4]. Given the complex structure of the craniofacial skeleton, the graft material must ideally be biocompatible and resilient, fast-setting, easily inserted, and able to be molded and integrate with surrounding bone in order to mimic the original bone structure [5][6][7][8].…”