Obliquely‐arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap

Lin, Yu Ting; Liu, Wen‐Chung; Wang, Kuan‐Ying; Lin, Yaoh‐Shiang; Yang, Kuo‐Chung

doi:10.1002/micr.30322

Cited by 10 publications

(8 citation statements)

References 33 publications

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“…20 Other advantages associated with the ALT include a large, customizable skin paddle, the presence of multiple perforators, an opportunity for vascularized nerve transfer (as shown in two patients in our series), and a more acceptable donor site morbidity than with the RFA. 21 Despite technical concerns that have been voiced by the surgical community with the transfer of two free flaps, we did not observe significantly increased total flap or skin paddle loss complication rates when compared with patient outcomes with single flap transfers. We evaluated the transfer of 55 free flaps with a total of three total flap losses, yielding a total flap success rate of 95%.…”

Section: Discussioncontrasting

confidence: 59%

Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction

Raghuram

Manfro²,

Teixeira

et al. 2021

J Reconstr Microsurg

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Background Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap. Methods We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t-tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups. Results In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications (p = 0.41) or flap/skin paddle loss (p = 0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction. Conclusion As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.

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Section: Discussioncontrasting

confidence: 59%

Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction

Raghuram

Manfro²,

Teixeira

et al. 2021

J Reconstr Microsurg

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“…3 The chimeric fibula free flap with double skin paddles later became an option. [6][7][8][9][10] Studies on perforator anatomy by Jones et al and Yu et al showed the traditional distal skin paddle to be extremely reliable with up to 3 septocutaneous perforators. 4,5 A proximal musculocutaneous perforator was present in 67%-84% of cases that could supply the proximal skin paddle.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Anatomical studies of perforator anatomy have found a common musculocutaneous perforator that can supply a separate, proximal skin paddle in the fibula free flap, which has expanded its reconstructive uses. [4][5][6][7][8][9][10] We present the reconstruction of a complicated and extensive mandibulofacial defect using one of the largest reported fibula free flaps.…”

Section: Introductionmentioning

confidence: 99%

Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

Chen

Tamaki

Özer

2020

Ann Otol Rhinol Laryngol

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Objective: Extensive mandibulofacial defects can be challenging to reconstruct. We present the case of a complex mandibulofacial defect reconstructed with a mega, chimeric fibula free flap. Methods: Ablation of the oral cavity tumor resulted in a large defect involving mandible, floor of mouth, and tongue. Skin of the chin and neck as well as the lower lip were also resected. A fibula free flap was harvested with the skin paddle involving most of the lateral compartment. Results: The fibula free flap was split into proximal (80 cm2) and distal (120 cm2) skin paddle islands, which were supplied by separate perforators off the peroneal artery. The intraoral soft tissue defect was reconstructed with the proximal skin paddle while the skin was recreated with the distal skin paddle. A Karapandzic flap was used to reconstruct the lower lip. Conclusions: The traditional fibula free flap skin paddle often does not provide sufficient soft tissue coverage for large mandibulofacial defects. Some surgeons opt to harvest a second free flap. We describe our technique for using the mega fibula free flap – one of the largest reported in the literature – as a single mode of reconstruction.

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“…The osteocutaneous fibular flap, described first by Hidalgo in 1989 for mandibular reconstruction (Hidalgo, 1989), underwent continued evolution of flap design to improve its soft‐tissue characteristics. Several modifications have been developed, for instance providing a second skin island using three different techniques: a central de‐epithelialized skin paddle (Deleyiannis et al, 2008; Jones et al, 2003; Yadav et al, 2012), a distally‐based double‐skin paddle (DSP) (Kubo et al, 2013; Lin et al, 2019; Maciejewski et al, 2008; Yang et al, 2000), or a proximally and distally‐based DSP (Chang & Yu, 2017; Cheng et al, 2009; Kannan et al, 2013; Leclère et al, 2014; Potter et al, 2014; Roan et al, 2013; Yu et al, 2011) (Figure 1). However, according to the current literature, no optimal reconstructive method has been standardized.…”

Section: Introductionmentioning

confidence: 99%

Oromandibular reconstruction with double‐skin paddle fibular free flap: A systematic review and meta‐analysis

et al. 2021

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Background Reconstruction of complex head and neck defects is challenging, especially when more than one soft‐tissue subunit is involved. The osteocutaneous fibular flap underwent continual evolution to improve its soft‐tissue characteristics, such as including a second skin island. The purpose of this study was to evaluate outcomes regarding oromandibular reconstruction with a double‐skin paddle fibular free flap (DSPFFF) using three different techniques: central de‐epithelialized skin paddle, distally‐based double‐skin paddle (DSP), or proximally and distally‐based DSP. Methods A systematic review was performed in December 2020 using Pubmed and MedLine Ovid databases according to the PRISMA guidelines. A meta‐analysis of functional outcome and complications was performed to estimate single incidence rates. Results A total of 449 patients were included, with a follow‐up of 1–84 months, where 330 patients underwent reconstruction with the first technique, 23 patients with the second technique, and 96 patients with the third technique. The meta‐analysis showed an overall good functional outcome and a low‐complication rate for oromandibular reconstruction with DSPFFF. A better functional outcome and a lower complication rate were found when a distally‐based DSPFFF was harvested compared to a proximally and distally‐based DSPFFF. Conclusion The DSPFFF was found to be useful and reliable for reconstructing composite and extensive head and neck defects, with an overall good functional outcome and a low‐complication rate. The meta‐analysis showed a better positive outcome on distally‐based DSPFFF rather than proximally and distally‐based DSPFFF. In addition, distally‐based DSPFFF showed a lower complications rate when compared with proximally and distally‐based DSPFFF.

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Obliquely‐arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap

Abstract: With the design of obliquely-arranged double paddles, we may maximize the harvested skin area of lateral lower leg to reconstruct an extensive head and neck defect with a single free flap.

Cited by 10 publications

References 33 publications

Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction

Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction

Mega Fibula Free Flap for Reconstruction of an Extensive Mandibulofacial Defect

Oromandibular reconstruction with double‐skin paddle fibular free flap: A systematic review and meta‐analysis

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