Crescent‐shaped skin paddle for a fibular flap: Avoiding skin grafting at the donor site

Abstract

A fibular osteocutaneous flap is the mainstay of oromandibular reconstruction. This report aimed to present a crescent‐shaped skin paddle, a novel fibular skin paddle designed to achieve both sufficient intraoral lining and primary closure of the donor site. A 3–5‐cm‐wide crescent‐shaped skin paddle was harvested according to the locations of the distal septocutaneous perforators on preoperative color Doppler sonography. This narrow skin paddle fits well morphologically into the mucosal defect, enabling a reliable intraoral lining. This advantage becomes more evident when the mandibular defect crosses the midline or extends posteriorly to the maxillary tuberosity as the shape of the mucosal defect becomes arcuate. Primary closure of the donor site is easier to achieve because the required width of the crescent‐shaped skin paddle is minimized. This method reduces donor‐site morbidity associated with skin grafting while ensuring safe intraoral closure with a fibular osteocutaneous flap.

Response: Indocyanine green angiography is not an ideal modality for peroneal artery perforator mapping

“…2 The situation may be different when the skin island is planned to extend far proximally and includes multiple perforators. 3 However, the need for inclusion of additional proximal perforators can be questioned in light of the fact that a single, eccentrically positioned distal perforator can perfuse large areas of skin-the very principle of propeller flaps. 4 Miyamoto et al themselves describe uneventful healing in a case in which no proximal perforator could be included.…”

“…4 Miyamoto et al themselves describe uneventful healing in a case in which no proximal perforator could be included. 3 Knowledge of the exact point at which the perforator enters the skin (or subdermal plane) is relevant primarily when planning extra slim skin islands: the closer the incision can be made to this point, the narrower the skin island can be designed, and the more reliably a primary closure can be achieved. In this regard, ICGA clearly prevailed over US-bT.…”

“…4 Miyamoto et al themselves describe uneventful healing in a case in which no proximal perforator could be included. 3…”

“Indocyanine green angiography is not an ideal modality for the peroneal artery perforator mapping”

“…1052e Plastic and Reconstructive Surgery • June 2023 developed a novel crescent-shaped skin paddle design for oromandibular reconstruction using the fibula to avoid skin grafting on the donor site. 5 In this technique, the perforator location is marked by color Doppler ultrasonography before the surgery. Then, the skin paddle, including the markings, is narrowed to the minimum necessary to allow for primary donor-site closure (Figs.…”

Small saphenous vein interposition graft in free fibular flap transfer for mandibular reconstruction in a patient

“…Segmental mandibulectomy including the contralateral canine but not the ipsilateral condyle was performed. The fibular osteocutaneous flap was harvested from the left leg as described previously (Miyamoto et al, 2022). The vascular pedicle, including two peroneal veins, was dissected as close to its origin as possible.…”