Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

Hsu, Honda; Chen, Peir-Rong; Chien, Shu; Lee, Jiunn-Tat

doi:10.1177/0194599814549731

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…After its first description for intraoral reconstruction, 31 this flap has also been used for covering other defects in the head and neck, 32,33 and success rates of at least 90% are regularly achieved. To create the least possible donor site morbidity (a short pedicle flap with direct closure), there must be adequate recipient vessels, and the size of the defect must allow direct closure.…”

Section: Soleus Perforator Flapmentioning

confidence: 99%

Perforator flaps: the next step in the reconstructive ladder?

Wolff

2015

British Journal of Oral and Maxillofacial Surgery

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Section: Soleus Perforator Flapmentioning

confidence: 99%

Perforator flaps: the next step in the reconstructive ladder?

Wolff

2015

British Journal of Oral and Maxillofacial Surgery

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“…We used the proximal lateral leg flap in patch esophagoplasty because 1) the flap is thin and flexible, which avoids disfiguring the neck contour; 2) there is no need to sacrifice any main artery; 3) it is also possible to close the donor site primarily if the width of flap is <6 cm 6 ; 4) it is away from the reconstructive region and therefore allows for a two‐team approach; and 5) there is almost no donor‐site morbidity. The main drawbacks of this flap are its small arterial caliber (1.3 ± 0.3 mm) and short pedicle length (5–9 cm) . In our case, the vascular size discrepancy was overcome by anastomosing the pedicle vessels to the recipient vessels end‐to‐side, and the short pedicle length was overcome by placing the perforator eccentrically and using proximal de‐epithelialization.…”

Section: Discussionmentioning

confidence: 80%

Patch esophagoplasty with a free proximal lateral leg flap for focal stricture of the cervical esophagus: A case report

2016

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Esophageal stricture after surgery or trauma is a major reason for poor oral nutrition, body-weight loss, and general damage to health. Patch esophagoplasty, after repeated failed dilation attempts, is recommended for focal esophageal strictures. In this report, we present a case in which a free proximal lateral leg flap was used for reconstruction of focal stricture of the cervical esophagus. A 62-year-old man developed progressive dysphagia after hypopharyngeal cancer ablation and adjuvant radiotherapy. He was referred for surgical interventions after repeated failed dilation attempts. Preoperative evaluation revealed a 3-cm segment stricture of the cervical esophagus without evidence of an additional distal stricture. Patch esophagoplasty with free tissue transfer was planned. After the stricture site had been explored, the fibrotic tissue was resected. A pathology report confirmed no evidence of malignancy. The resultant defect in an otherwise healthy posterior esophageal wall was reconstructed using a proximal lateral leg flap. Recovery was uneventful and the functional outcome was satisfactory at the 6-month follow-up. For the radiated patients with cervical esophageal focal strictures, we introduced a novel use of the proximal lateral leg flap in patch esophagoplasty because of its unnoticeable donor site morbidity and its thin and pliable nature. © 2016 Wiley Periodicals, Inc. Microsurgery 37:426-430, 2017.

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“…With the one case example that we had in the study, we were able to harvest a skin paddle as large as 16 × 8 cm and yet achieve primary closure without tension of both donor sites. The perforator to the proximal lateral leg flap is located within the proximal third of the lower leg, and it is reliably found in more than 90% of clinical cases (Chang et al, 2013; Hsu, Chen, Chien, & Lee, 2014; Lee et al, 2015; Potter, Lee, Oxford, Wong, & Saynt‐Cyr, 2014). This perforator arises from the peroneal system in 70–80% of cases and, with a reasonably sized pedicle length, it is ideal in combination with a fibula bone flap.…”

Section: Discussionmentioning

confidence: 99%

Experience on primary closure of fibular flap donor sites and development of an algorithm for closure based on different flap designs

et al. 2020

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Background: Most skin paddles of the fibula flap are harvested from the distal third of the lower leg, skin grafting for the donor-site is necessary. Methods: A retrospective review was done on patients with large bony defects using free fibula osteocutaneous flaps (FOSCFF) for head and neck reconstruction. We focus on the techniques for closure of donor sites were skin grafting, primary closure with tear drop design and propeller flap technique on the donor site closure using skin graft, primary closure and local propeller flap based on the different location of perforators of FOSCFF. Postoperative follow up include incidence of wound complications, postoperative days to ambulation and cosmetic outcome. Results: A total of 48 patients were included. Twenty five patients had skin graft (Group A), and 23 patients had primary closure (Group B); in 16 patients tear-drop design was used, 6 had propeller flap, and the remaining 1 patient received a chimeric flap. Group A had more wound complication rates compared to Group B; 20% versus 4.3%, respectively (p = .19). The average postoperative days to ambulation for Group A were 15.1 days versus 7.3 days for Group B (p < .001). The cosmetic score in the B group (2.71) versus A group (4.89) was also statistically significant (p = .007). All the patients ambulated well at follow up. Conclusion: Primary closure using the tear drop technique and propeller flap is superior to skin grafting in terms of better cosmetic appearance, earlier postoperative ambulation, and no need for another donor site for skin graft.

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Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

Abstract: This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

Cited by 5 publications

References 22 publications

Perforator flaps: the next step in the reconstructive ladder?

Perforator flaps: the next step in the reconstructive ladder?

Patch esophagoplasty with a free proximal lateral leg flap for focal stricture of the cervical esophagus: A case report

Experience on primary closure of fibular flap donor sites and development of an algorithm for closure based on different flap designs

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