The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects.

Background: Donor site morbidity is a significant drawback of the radial forearm flap. The purpose of this study is to describe a new shape-modified technique. The donor site morbidity was compared to that of the conventional technique, in terms of the esthetic, functional outcomes, and quality of life (QOL). Methods: This is a prospective study of 30 patients with oral cancer who underwent reconstruction using radial forearm flaps, in two groups. Results: Regarding the donor site characteristics, the differences in the time for healing (P = .006), the scar score (P < .0001), and the QOL score (P < .0001) were significant. The number of patients with sensory deficit was 11 in the conventional group and 3 in the shape-modified group (P = .009). Conclusions: The functional and esthetic outcomes of the donor site were better for the shape-modified technique. It is best suited for small defects. Compromise of the pedicle length is a limitation.

Background:Though advances in microsurgery have resulted in better survival rates of replants, replanting crushed and avulsed digits are difficult. If replantation is not possible these digits need local tissue cover to retain length.Patients and Methods:Twenty seven patients underwent distally based cross finger flaps for coverage of exposed vital structures over the amputation stumps.Results:All the flaps survived well. They provide good quality thin pliable tissue over the fingertips and help in achieving near normal range of movements in injured digits.Conclusion:Distally based cross finger flap gives tissues of right dimensions, at the most desired site, making reconstruction of these difficult problems quiet easy.

Introduction Reconstruction has evolved long way from primary closure to flaps. As time evolved, better understanding of vascularity of flap has led to the development of innovative reconstructive techniques. These flaps can be raised from various parts of the body for reconstruction and have shown least donor site morbidity. We use one such peroneal artery perforator flap for tongue reconstruction with advantage of thin pliable flap, minimal donor site morbidity and hidden scar. Materials and Methods Our patient 57yrs old lady underwent wide local excision with selective neck dissection. Perforators are marked about 10 and 15 cm inferiorly from the fibular head using hand held Doppler. Leg is positioned in such a way to give better exposure during dissection of the flap and flap is harvested under a tourniquet with pressure kept 350 mm Hg. The perforator is kept at the eccentric location, so as to gain length of the pedicle. Skin incison is placed over the peroneal muscle and deepened unto the deep facia, then the dissection is continued over the muscle and the perforator arising from the lateral septum. The proximal perforator about 10 cm from the fibular head is a constant perforator and bigger one, which is traced up to the peroneal vessel. We could get a 6 cm of pedicle length. Finally the flap is islanded on this perforator and the pedicle is ligated and flap harvested. Anastamosis was done to the ipsilateral side to facial vessels. The donor site is closed primarily and in the upper half one can harvest 5 cm width flap without requiring a skin graft along with a length of 8 to 12 cm. Discussion Various local and free flap has been used for reconstruction of partial tongue defects with its obvious donor site problems, like less pliable skin and not so adequate tissue from local flaps and sacrificing a important artery as in radial forearm flap serves as the work horse in reconstruction of partial tongue defects, Concept of super microsurgery was popularized by Japanese in 1980s and the concept of angiosome proposed by Taylor paved the way for development of new flaps. True perforator flaps are those where the source vessel is left undisturbed and overlying skin flap is raised. Yoshimura proposed cutaneous flap could be raised from peroneal artery (Br J Plast Surg 42:715-718, 1989). Wolff et al. (Plast Reconstr Surg 113:107-113, 2004) first used perforator based peroneal artery flap for oral reconstruction. Location of perforators vary, hence pre operative localisation can be done by ultrasound doppler, CT angio or MR angiography. Disadvantages over radial flap include varying anatomic location of perforators, need for imaging and difficult dissection of delicate vessels through muscles and hence a learning curve. Our patient had an arterial thrombus within few hours post-operatively which was successfully salvaged with immediate re-exploration and re-anastomosis of artery. Post-operative healing was uneventful and donor site was closed primarily without the need for graft. Conclusions Perforator ...