title: Oromandibular reconstruction with chimeric double-skin paddle flap based on peroneal vessel axis for synchronous opposite double oral cancer.
abstract: BACKGROUND
  Synchronous double oral cancer represents the minority of cases of head and neck cancer. After tumor ablation, 2 separate oromandibular defects, even combined with a through-and-through oral defect, pose a serious reconstructive challenge. The ideal method for reconstruction remains controversial.
  
  
  OBJECTIVE
  Based on the peroneal vessel axis, a chimeric double-skin paddle peroneal fasciocutaneous or fibular osteomyocutaneous flap could be designed to accomplish the difficult reconstruction.
  
  
  METHODS
  Six male patients, each with 2 separate oromandibular defects after tumor ablation of synchronous double oral cancer, received double-skin paddle flap reconstruction with 3 peroneal fasciocutaneous and 3 fibular osteomyocutaneous flaps.
  
  
  RESULTS
  All 6 flaps survived; however, complications included 1 skin paddle lost due to insufficient perfusion of a visible perforator, and 1 superficial necrosis occurring over the tip of a longer skin paddle. One postoperative intraoral infection and 1 donor site infection were also reported. During follow-up, 3 months later, 1 patient succumbed to local recurrence and bony metastasis. One patient developed a new cancer in the maxillary gingiva, and another had osteoradionecrosis 8 months later. Four patients gained acceptable cosmesis with good oral competence.
  
  
  CONCLUSIONS
  A chimeric flap based on the peroneal artery could provide a segment of fibular bone, 1 or 2 skin paddles, and a cuff of the flexor hallucis longus muscle simultaneously. For 1-stage reconstruction of separate oromandibular defects after tumor ablation of synchronous double oral cancer, this design could provide all components at 1 transfer.
authors: From the *Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung; and †National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China.
authors: Shih-Tsai
authors: ST
authors: Huang
authors: Wen-Chung
authors: WC
authors: Liu
authors: Lee-Wei
authors: LW
authors: Chen
authors: Kuo-Chung
authors: KC
authors: Yang
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps