Avoiding second donor site and the second set of neck vessels in a case of absent peroneal skin perforators

This report describes the procedure of a case in which the skin paddle of the free fibula flap derived its supply solely from a soleal musculocutaneous perforator originating from the posterior tibial system. In contrast, the osteo-muscular component was supplied by the peroneal vascular system. We harvested the skin paddle with its vascular supply from the posterior tibial artery separately, and the osteo-muscular fibula was harvested with its supply from peroneal vessels. In this way, we avoided violation of the second donor site for the skin paddle. In addition, we used the distal end of peroneal vessels to salvage our skin paddle instead of sacrificing another set of neck vessels for anastomosis. This technique may also be utilised in cases where the neck vessels may not be available due to previous surgeries, radiation therapy, or decision by the surgery team to not sacrifice two sets of neck vessels for anastomosis.

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Skin paddle vascularity of free fibula flap - A study of 386 cases and a classification based on contribution from axial vessels of the leg

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.96586 ◽

2012 ◽

Vol 45 (01) ◽

pp. 058-061 ◽

Cited By ~ 6

Author(s):

Prabha S. Yadav ◽

Quazi G. Ahmad ◽

Vinay K. Shankhdhar ◽

G.I. Nambi

Keyword(s):

Blood Supply ◽

Sole Source ◽

Vascular Supply ◽

Free Fibula Flap ◽

Skin Paddle ◽

Fibula Flap ◽

Study Results ◽

Different Types ◽

Free Fibula ◽

Vascular Contribution

ABSTRACT Objective: The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems. Materials and Methods: A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied. While majority of the skin paddles received their blood supply from the peroneal septocutaneous perforators, a few had their dominant supply from the soleus musculocutaneous perforators in addition to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous perforators were the sole source of blood supply to the skin paddle. The limitation in this study was the inability to augment the clinical observation with cadaveric study. Results: The skin paddle of the free fibula flap was classified into four different types (a-d) based on the dominance of vascular contribution by axial vessels of the leg. Conclusion: The skin paddle of the free fibula flap has reliable blood supply, but a thorough knowledge of the variations in vascular pattern of the skin paddle is required especially to salvage the larger paddles used in the reconstruction complex oro-mandibular defects.

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Mandibular Reconstruction with Free Fibula Flap: Experience at Hayatabad Medical Complex, Peshawar

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v8i4.374 ◽

2019 ◽

Vol 8 (4) ◽

pp. 198-202

Author(s):

Syed Asif Shah ◽

Irfan Ullah ◽

Muhammad Bilal ◽

Mohammad Hamayun Shinwari ◽

Adeeba Ahmad ◽

...

Keyword(s):

Success Rate ◽

Donor Site ◽

Graft Loss ◽

Tumor Resection ◽

Mandibular Reconstruction ◽

Diabetic Patients ◽

Free Fibula Flap ◽

Skin Paddle ◽

Fibula Flap ◽

Free Fibula

Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.

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Long-term donor-site morbidity after vascularized free fibula flap harvesting: Clinical and gait analysis

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.10.007 ◽

2016 ◽

Vol 69 (2) ◽

pp. 262-269 ◽

Cited By ~ 27

Author(s):

Damien Feuvrier ◽

Yoshimasa Sagawa ◽

Samuel Béliard ◽

Julien Pauchot ◽

Pierre Decavel

Keyword(s):

Gait Analysis ◽

Donor Site ◽

Donor Site Morbidity ◽

Free Fibula Flap ◽

Fibula Flap ◽

Free Fibula

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Risk Factors for Early and Late Donor-Site Morbidity After Free Fibula Flap Harvest

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2015.01.036 ◽

2015 ◽

Vol 73 (8) ◽

pp. 1637-1640 ◽

Cited By ~ 21

Author(s):

Peng Li ◽

Qigen Fang ◽

Jinxing Qi ◽

Ruihua Luo ◽

Changfu Sun

Keyword(s):

Risk Factors ◽

Donor Site ◽

Donor Site Morbidity ◽

Free Fibula Flap ◽

Fibula Flap ◽

Free Fibula

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How to Harvest The Free Fibula Flap

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v7i1.295 ◽

2020 ◽

Vol 7 (1) ◽

pp. 4-6

Author(s):

Parintosa Atmodiwirjo ◽

Mohamad Rachadian Ramadan ◽

Sara Ester Triatmoko ◽

Nadhira Anindita Ralena

Keyword(s):

Free Flaps ◽

Free Fibula Flap ◽

Skin Paddle ◽

Advantages And Disadvantages ◽

Free Fibular Flap ◽

Free Fibula ◽

Physical Examinations ◽

Fibular Free Flap ◽

Fibular Flap ◽

Composite Flap

Summary: Free fibular flap (FFF) is a composite flap consisting of fibular bone and skin paddle. Muscle may be added to the flap. It has several advantages and disadvantages. The fibular free flap is well suited for any reconstruction of the head and neck. It is suitable for defects of the anterior mandibular arch or lateral defects in patients who wish to undergo osseointegrated dental reconstruction. Meanwhile, its contraindications are related to significant atherosclerotic diseases the patient has or congenital variants of the arteries. Preparations for FFF procedure consist of history taking, physical examinations and supporting examinations, like other free flaps procedure in general. Several intraoperative preparations should also be done.

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Dental Rehabilitation for Free Fibula Flap-Reconstructed Mandible with Scar Contracture: A Technical Note

Dentistry Journal ◽

10.3390/dj7030065 ◽

2019 ◽

Vol 7 (3) ◽

pp. 65 ◽

Cited By ~ 1

Author(s):

Masaya Akashi ◽

Kousuke Matsumoto ◽

Daisuke Takeda ◽

Junya Yamashita ◽

Nanae Yatagai ◽

...

Keyword(s):

Polyglycolic Acid ◽

Technical Note ◽

Free Fibula Flap ◽

Removable Partial Denture ◽

Common Procedure ◽

Skin Paddle ◽

Scar Contracture ◽

Fibula Flap ◽

Dental Rehabilitation ◽

Free Fibula

Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. We herein report dental rehabilitation of a free fibula-reconstructed mandible with scar contracture. A vestibuloplasty technique with application of a polyglycolic acid (PGA) sheet is described. The implants were inserted into a viable fibula flap with severe scar contracture of the overlying epithelium resulting from vascular instability in skin paddle. Only the fibula periosteum was sutured after implant insertion; exposed surfaces were covered with a combination of PGA sheet and fibrin sealant. The area with PGA sheet coverage gradually healed with moderate contracture. The epithelium around the almost implants became immobilized. The implant-supported removable partial denture with custom titanium bar was acceptable. Dental rehabilitation is possible for reconstructed mandibles with severe scar contracture. Application of a PGA sheet may be useful for vestibuloplasty in patients with reconstructed mandibles.

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