Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Fang, Jugao; Huang, Zhigang; Chen, Xiaohong; Hou, Lingling; Zhang, Yang; Li, Pingdong; Xu, Hongbo

doi:10.21147/j.issn.1000-9604.2017.03.09

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…Since that time, the PTAFF has been described for reconstruction of skin, oral cavity, palate, partial maxilla, oropharynx, cervical esophagus, trachea, and hypopharynx [15,16 ▪▪ ,17–21].…”

Section: Historymentioning

confidence: 99%

The posterior tibial artery free flap for head and neck reconstruction

Kejner¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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The posterior tibial artery free flap (PTAFF) has been a mainstay of lower extremity reconstruction. Over the past 30 years, it has been intermittently used for head and neck reconstruction with recent renewed interest given its versatility. Recent findingsUse of the PTAFF in head and neck reconstruction is expanding along with the continued evolution of microvascular techniques. Differences in overall health, incidence of smoking, and body habitus can impact the utility of this flap and should be taken into consideration when choosing to use it.

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Section: Historymentioning

confidence: 99%

The posterior tibial artery free flap for head and neck reconstruction

Kejner¹

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…The medial leg offers a broad area for harvest of a fasciocutaneous ap with adequate reach tissues for coverage of the inferior heel, achilles tendon, medial and anterior ankle, and dorsal midfoot wounds 24 . In 2008, Dr. Raymond W. M. Ng reported the rst series of PTAFs for defects in head and neck 6 , which has been utilized more in recent years 3,[7][8][9][10][11][12][13][14][15][16]26,27 . Table 3 showed the current literature regarding the application of PTAFs in head and neck reconstruction around the world until July 2022, in which PTAFs were mostly used in oral and maxillofacial regions, where a thin, pliable ap is recommended to prevent any long-term complications such as dysphagia, speech compromising, cicatricial trismus when opening mouth, decreased tongue mobility 2 .…”

Section: Discussionmentioning

confidence: 99%

“…However, tumor resection causes damage to the head and neck, resulting in problems with swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life 2 . Defects of head and neck, however, continue to present a di cult reconstructive challenge to the reconstructive surgeon, and ap reconstruction is an important aspect of the radical surgery which recover the shape and improve the postoperative function (3). Many approaches to head and neck reconstruction have been used, including some local aps like supraclavicular artery perforator ap 3 , and pedicled aps like pectoralis major myocutaneous (PMMC) ap 5 , and free aps such as radial free forearm and free thigh anterolateral aps 2 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, PTAFs have several advantages compared with other aps. Compared with RFFF, PTAFs have more advantages such as longer vascular pedicle, more abundant soft tissue, tougher skin, and lower donor-site complication rate3 while the PTAFs share thinness with RFFF because the embryologic development of the upper limb and lower limb are very similar 6 . Compared with ALT which is one of the popular aps in the head and neck reconstruction, PTAFs reconstruction could achieve similar results and the donor site can be closed primarily while the result of ALTs transplant is affected by variable thickness in the Westerner 6 , and attempts at primary thinning of the ALTs may compromise vascularity and carry a risk of necrosis (28).…”

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confidence: 99%

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Free posterior tibial artery perforator flapin head and neck reconstruction after tumor expiration

Shi

Deng

et al. 2022

Preprint

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Objectives: The purpose of this study was to examine the anatomical features, clinical applications, and complications of the free posterior tibial flap in head and neck reconstruction.Methods： Patients treated with free posterior tibial artery perforator flap in head and neck surgery were retrospectively viewed. Results： A total of 55 patients underwent reconstruction with a free posterior tibial artery perforator flap. Most of the patients had carcinoma of pharynx, trachea, oral and maxillofacial region. The flap dimension ranged from 7.5 cm2 to 108 cm2. The mean thickness of the flap was 1cm. The average length of the vascular pedicle is about 10 cm. Functional recovery of reconstruction area was studied 5~100 months after surgery. The flap survival rate was 98.1%. Specifically speaking, 3 patients developed Partial flap loss and 1 patient developed Total flap loss. Regarding ablative site complications, 6 patients developed wound infection, 2 of them, and another 2 patients developed pharyngeal fistula in the ablative area. Regarding donor site complications, 7 patients developed delayed wound healing and 5 patients developed skin graft necrosis. None of the patients complained of walking difficulty in daily life.Conclusion: Free posterior tibial artery perforator flap as a relatively novel flap, with stable blood supply, thin thickness, flexible cortex, long vascular pedicle, and concealed donor area, is very suitable for head and neck reconstruction. Though PTAFs harvest will produce a minor donor site morbidity which could be solved mostly by conservative treatment, we think PTAFs will become one of the popular techniques for reconstruction of head and neck soft tissue defects.

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“…Specifically in the head and neck settings, in 2014 Chen et al (Chen et al, 2014) used the free posterior tibial flap to reconstruct the hypopharynx, reaching a 100% survival rate and preserving the laryngeal and pharyngeal function in all cases. After them, Zhong et al, 2017 described a small case series using a free medial tibial flap with posterior tibial artery to reconstruct various defects after tumor resections, showing several benefits, such as the efficacy of this solution when a thin‐layer epithelium is required, and the possibility of a two‐team approach. However, none of these works described a proper chimeric fashion of the flap, which offers the great advantage of versatility at the recipient site.…”

Section: Discussionmentioning

confidence: 99%

Free double‐paddle posterior tibial artery perforator flap for hypopharynx reconstruction: A case report and literature review

et al. 2021

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Microsurgical free tissue transfer is nowadays considered to be one of the main options for head and neck reconstruction. The free posterior tibial artery perforator (PTAP) flap is a well‐known reconstructive technique for local defect coverage in the distal leg, and only recently has been employed for head and neck reconstructions. Being a very thin and pliable flap, with low donor site morbidity and constant anatomy, the PTA perforator‐based flap could be a great alternative to the more commonly‐employed radial forearm free flap (RFFF). The present case report shows a complex head and neck defect coverage by means of a free double‐paddle PTA flap, with a concise literature review of previous PTA flap descriptions in this setting. A 59‐year‐old male patient presented with a hypopharynx leakage after radiotherapy due to hypopharynx carcinoma. Since the patient had an occluded ulnar artery on the left side and an arterial line in the radial artery on the right side, both a RFFF and an ulnar artery perforator (UAP) flap were contraindicated. Moreover, two different cutaneous flaps were needed to reconstruct a 6 × 8 cm2 defect, one for the reconstruction of the hypopharynx and one for the resurfacing of the neck, since previous surgeries and radiotherapy led to severe fibrosis of the neck. The patient had a BMI of 25.4 kg/m2, which led us to exclude the anterolateral thigh (ALT) flap because of its thickness. For the forementioned reasons, an unconventional double‐paddle PTAP flap based on two perforator vessels was chosen. Based on two perforators, two skin islands were harvested, building a double‐paddle PTA perforator‐based flap. The proximal skin island was 6 × 7 cm2 and the distal one was 6 × 4 cm2. The larger skin flap was set at the leakage of the hypopharynx. The smaller skin island was used to monitor the survival of the whole flap and for resurfacing the outer side of the neck. The postoperative course was uneventful and at 3 months follow up the reconstructive result was good with no functional drawback. In view of the obtained result, we can consider that the PTA flap might be a reliable alternative to the much widely used RFFF, with a minor donor site morbidity, for delicate head and neck reconstructions.

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Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Cited by 7 publications

References 9 publications

The posterior tibial artery free flap for head and neck reconstruction

The posterior tibial artery free flap for head and neck reconstruction

Free posterior tibial artery perforator flapin head and neck reconstruction after tumor expiration

Free double‐paddle posterior tibial artery perforator flap for hypopharynx reconstruction: A case report and literature review

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