title: Peroneal perforator flap for intraoral reconstruction.
abstract: Thin and pliable flaps with long, high calibre pedicles are ideally suited to lining the inside of the mouth. The radial forearm free flap has been our flap of choice until now, but we are unhappy with its potential for complications at the donor site. As an alternative, 30 patients have been treated in our unit with peroneal perforator flaps. Magnetic resonance (MR) angiography is necessary preoperatively to identify major perforating vessels. Flaps were raised using a lateral approach after the position of the most suitable perforator had been marked on the skin. The skin flaps were outlined in the proximal half of the lower leg with a maximum width of 5 cm to allow for direct closure of the wound. Five patients (of the original 35) were excluded after the results of MR angiography were known. All perforators identified on MR angiography could be exposed in the proximal half of the lower leg and most had a septocutaneous course. Reconstructions were in the floor of the mouth (n=16), tongue (n=11), and buccal mucosa (n=3). All but one flap survived with satisfactory functional results. The donor site morbidity was low. With the aid of MR angiography the peroneal perforator flap is a safe option for intraoral reconstruction. For small and medium sized defects we think that this flap is a good alternative to others, particularly if direct closure at an inconspicuous donor site is desired.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Wolff
authors.forename: Florian
authors.initials: F
authors.lastname: Bauer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wylie
authors.forename: Herbert
authors.initials: H
authors.lastname: Stimmer
authors.forename: Frank
authors.initials: F
authors.lastname: Hölzle
authors.forename: Marco
authors.initials: M
authors.lastname: Kesting
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002610:Cheek / Q000601:surgery; D005260:Female; D005360:Fibula; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000145:classification; D006085:Graft Survival; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007866:Leg / Q000098:blood supply; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D009060:Mouth Floor / Q000601:surgery; D009061:Mouth Mucosa / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery; D018482:Muscle, Skeletal / Q000637:transplantation; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods / Q000473:pathology; D020858:Tissue and Organ Harvesting / Q000379:methods; D014059:Tongue / Q000601:surgery