Peroneal Artery Perforator Chimeric Flap: Changing the Perspective in Free Fibula Flap Use in Complex Oromandibular Reconstruction

ABSTRACT

The fibula osteoseptocutaneous flap has undergone multiple refinements since its first description in oromandibular reconstruction. There is now a better understanding of the blood supply to the skin of the lateral aspect of the leg. Multiple free skin paddles can be harvested freestyle from the lateral aspect of the leg. The size of the flaps that can be harvested has not been clearly defined. A case report of a complex oromandibular reconstruction following a shotgun injury to the face demonstrates a way of maximizing the skin harvest. An osteoseptocutaneous fibula flap was used for the replacement of the mandible and the internal lining of the oral cavity. A larger lateral leg flap based on a musculocutaneous perforator of the peroneal artery was used for the external and full-thickness lower-lip defect. The latter flap by definition is a peroneal artery perforator flap, which to the best of my knowledge is terminology that has not been used in the English literature. The main purpose of this article is to review the blood supply of the lateral leg and how this can be utilized to reach the goals of a complex oromandibular and total lower-lip reconstruction.

KEYWORDS

Osteoseptocutaneous fibula flap - musculocutaneous perforators - peroneal artery - perforator flap

REFERENCES

• 1 Wei F C, Chen H C, Chuang C C, Noordhoff M S. Fibular osteoseptocutaneous flap: anatomic study and clinical application.  Plast Reconstr Surg. 1986;  78 191-200
• 2 Heitmann C, Khan F N, Levin L S. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels.  J Reconstr Microsurg. 2003;  19 157-162
• 3 Cho B C, Kim S Y, Park J W, Baik B S. Blood supply to osteocutaneous free fibular flap and peroneus longus muscle: prospective anatomic study and clinical applications.  Plast Reconstr Surg. 2001;  108 1963-1971
• 4 Chen Y L, Zheng B G, Zhu J M et al.. Microsurgical anatomy of the lateral skin flap of the leg.  Ann Plast Surg. 1985;  15 313-318
• 5 Schusterman M A, Reece G P, Miller M J, Harris S. The osteocutaneous free fibula flap: is the skin paddle reliable?.  Plast Reconstr Surg. 1992;  90 787-793
• 6 Winters H A, de Jongh G J. Reliability of the proximal skin paddle of the osteocutaneous free fibula flap: a prospective clinical study.  Plast Reconstr Surg. 1999;  103 846-849
• 7 Wei F C, Demirkan F, Chen H C, Chen I H. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer.  Plast Reconstr Surg. 1999;  103 39-47
• 8 Ao M, Asagoe K, Maeta M, Nakagawa F, Saito R, Nagase Y. Combined anterior thigh flaps and vascularised fibular graft for reconstruction of massive composite oromandibular defects.  Br J Plast Surg. 1998;  51 350-355
• 9 Blackwell K E, Buchbinder D, Biller H F, Urken M L. Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps.  Head Neck. 1997;  19 620-628
• 10 Sicilia-Castro D, Garcia-Perla A, Infante-Cossio P, Gutierrez-Perez J L, Gomez-Cia T, Garcia-Perla A. Combined fibula osteoseptocutaneous-lateral supramalleolar flap for reconstruction of composite mandibular defects.  Plastic Reconstr Surg. 2003;  111 2003-2008
• 11 Wei F C, Celik N. Perforator flap entity.  Clin Plast Surg. 2003;  30 325-329
• 12 Taylor G I, Pan W R. Angiosomes of the leg: anatomic study and clinical implications.  Plast Reconstr Surg. 1998;  102 599-616 discussion 617-618
• 13 Yang K C, Leung J K, Chen J S. Double-paddle peroneal tissue transfer for oromandibular reconstruction.  Plast Reconstr Surg. 2000;  106 47-55
• 14 Huang W C, Chen H C, Wei F C, Cheng M H, Schnur D P. Chimeric flap in clinical use.  Clin Plast Surg. 2003;  30 457-467
• 15 Jeng S F. Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series.  Plast Reconstr Surg. 2004;  113 19-23
• 16 Jeng S F, Kuo Y R, Wei F C, Su C Y, Chien C Y. Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters.  Plast Reconstr Surg. 2005;  115 1830-1836
• 17 Wei F C, Chuang S S, Yim K K. The sensate fibula osteoseptocutaneous flap: a preliminary report.  Br J Plast Surg. 1994;  47 544-547