Propeller Flaps in the Closure of Free Fibula Flap Donor Site Skin Defects

Abstract

The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects.

Fibula Osteoseptocutaneous Flap

“…26,29 Different techniques, such as a skin-stretching device allowing primary closure for skin defects ranging from 3 to 8 cm 30 and local propeller flaps based on the soleus musculocutaneous perforators, have been used for donor site skin closure. 31 However, these techniques are not suitable for very large skin defects. With our technique, muscle fascia of the anterior side is completely spared, allowing for direct fascial closure after flap harvest.…”

Perforator‐based propeller flap for fibula free flap donor site repair: A novel surgical technique

“…Although the technique has been popular in the orthopedics literature, it has not received much attention as a method of closing OCFFF donor sites for postablative head and neck defects. In a series of 10 patients, Sharma et al described using the propeller flap to close the OCFFF donor site . Their technique involves harvesting the OCFFF and then identifying and isolating a soleus musculocutaneous perforator originating from the posterior tibial artery upon which they base a perforator‐based propeller flap to close the fibula donor site .…”

“…In a series of 10 patients, Sharma et al described using the propeller flap to close the OCFFF donor site . Their technique involves harvesting the OCFFF and then identifying and isolating a soleus musculocutaneous perforator originating from the posterior tibial artery upon which they base a perforator‐based propeller flap to close the fibula donor site . However, their technique of harvesting the OCFFF first limits the utility of the propeller flap to the posterior tibial vessels.…”

Propeller flap donor site closure by means of another propeller flap: A case report and literature review

“…Skin grafting of a given flap's donor site can have negative functional and esthetic implications, and numerous attempts have been made in different body regions to provide a complete soft tissue restoration while avoiding skin grafting (Agostini & Lazzeri, 2012;Hallock, 2018;Lane, Swan, & Cassell, 2013). Among the various techniques reported in literature, perforator-based propeller flaps have also been successfully employed to address the secondary defect determined by the harvest of different types of flap (Iida, Yoshimatsu, & Koshima, 2017;Scaglioni, Barth, & Chen, 2018;Sharma et al, 2013). However, to date there have been no reports regarding the specific use of a propeller flap to aid in closure of another propeller flap's donor site.…”

“…Sharma et al described the use of propeller flaps based on the perforators coming through the lateral head of the soleus to provide closure of skin defects derived from free osteocutaneous fibula flaps harvest(Sharma et al, 2013). According to the authors, in eight out of 10 patients the propeller flap rotated by 180 allowed uneventful donor site closure avoiding the need for skin grafting which can lead to healing delays, especially when peroneal tendons are exposed.The high flap complication rate however (one case of partial necrosis and one of complete flap necrosis) mandates caution when considering this option.…”