Flow-through flap for salvage of fibula osseocutaneous vascular variations: a surgical approach and proposed modification of its classification.
The osseocutaneous fibula free flap is commonly used in mandibular reconstruction. Clinically important anatomic variants of the donor vessels have been reported. The authors describe a rare variant encountered while raising an osseocutaneous fibula flap. The fibula was supplied by the peroneal vessels and the overlying skin paddle was supplied by musculocutaneous perforators arising from the posterior tibial vessels. By raising 2 separate free flaps and configuring them in microvascular series with the fibula acting as a flow-through flap, the reconstruction was successful. Although the anatomic variant has been described, the authors' approach to it has not. The benefits of this method over other options include preservation of a skin paddle for monitoring and watertight oral closure and a long pedicle to the skin paddle permitting a wide arc of movement. The authors suggest a modification to the existing classification of perforators to the lateral leg skin to guide intraoperative decision making.
Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Electronic address: justinparr@live.com.au.
Justin M
JM
Parr
Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Brandon M
BM
Adams
Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Michael
M
Wagels
D000714:Anastomosis, Surgical / Q000379:methods; D063405:Anatomic Variation; D016025:Bone Transplantation / Q000145:classification*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005205:Fascia / Q000637:transplantation; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000145:classification; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000379:methods; D063175:Mandibular Reconstruction / Q000379:methods; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery; D061525:Perforator Flap / Q000098:blood supply* / Q000145:classification; D012867:Skin / Q000098:blood supply; D016038:Skin Transplantation / Q000145:classification*; D016909:Tibial Arteries / Q000033:anatomy & histology