Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach

Tiftikçioğlu, Yiğit Özer; Gur, Ersin; Gürler, Tahir

doi:10.1097/scs.0000000000003342

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…Therefore, skin flaps or free flaps with skin paddles have a great advantage in monitoring over isolated bone or muscle flaps (Guo et al, 2012). Second, it allows simultaneous soft tissue reconstruction with bone without the need for a second fasciocutaneous flap (Tiftikcioglu, Gur, & Gurler, 2017).…”

Section: Introductionmentioning

confidence: 99%

Flow through fibula and fasciocutaneous free flaps in oromandibular reconstruction

2022

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Introduction The osteocutaneous fibula is a workhorse flap for oromandibular reconstruction. Skin paddles not only perform soft tissue reconstruction but also serve as a monitor for the fibula. In cases where the skin paddle cannot be harvested as desired due to variations, two challenges arise, such as fibula follow‐up and the need for a second free flap so recipient. Moreover, there may not be enough recipient vessels for the double flaps in the neck. This report aimed to address the difficulties mentioned above with the use of flow‐through free flaps in composite oromandibular reconstructions. Patients and Methods Between 2019 and 2021, five (three Female, two Male) patients underwent flow‐through technique as free fibula and fasciocutaneous flaps due to variations in fibular skin paddle or insufficiency of recipient vessels in the neck. Ages of patients were between 45 and 75 years. Four patients underwent surgery for tumor and one patient for the result of radionecrosis. ALT, chimeric ALT, and RFFF were selected as second free flaps. Results The size of the fasciocutaneous flaps ranged from 6 × 4 cm to 14 × 11 cm. Mandibular defects ranged from 6 to 16 cm. 1 venous occlusion occurred post‐op 1st day and was salvaged. One hematoma and one wound dehiscence occurred postoperatively and were salvaged successfully. One Partial tongue necrosis occurred due to previous radiotherapy and additional tumor surgery. No additional complication occurred. All flaps survived. Follow‐up period was between 3 months and 2 years. Patient who had tongue necrosis experienced swallowing and speech difficulty and Percutaneous endoscopic gastrostomy tube was placed post‐operative 2 months. Functional finale outcomes were successful for other patients. Conclusion Flow‐through technique provides fibula monitoring with avoiding to find second recipient. Customizing free flaps under more favorable conditions as on the operation table before fixation of the bone can be a useful approach.

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Section: Introductionmentioning

confidence: 99%

Flow through fibula and fasciocutaneous free flaps in oromandibular reconstruction

2022

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Mandibular reconstruction in head and neck cancer: which is the gold standard?

Molteni

Gazzini

Sacchetto

et al. 2023

Eur Arch Otorhinolaryngol

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Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction

et al. 2020

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Rationale: Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel. Patient concerns: A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us. Diagnosis: Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma. Interventions: The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle. Outcomes: The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up. Lessons: The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.

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Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach

Cited by 3 publications

References 32 publications

Flow through fibula and fasciocutaneous free flaps in oromandibular reconstruction

Flow through fibula and fasciocutaneous free flaps in oromandibular reconstruction

Mandibular reconstruction in head and neck cancer: which is the gold standard?

Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction

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