Peroneal Flap for Tongue Reconstruction

Abstract

For large tongue defects, reconstructive surgeons have devised a variety of feasible options, such as radial forearm free flap and anterolateral thigh (ALT) flap. In our institution, peroneal flap has been the workhorse flap for the soft tissue defect in head and neck reconstruction. We present our experience using peroneal flap in tongue reconstruction. The study included 47 patients who had undergone tongue reconstructions with peroneal flaps after tumor resection. The size and location of the defect after tumor resection determined whether the peroneal flaps could be harvested as pure septocutaneous flaps to solely reconstruct the neotongue or to carry an additional muscle bulk to fill the adjacent defect. Retrospective chart review was used to look for postoperative complications and to perform functional assessments (which were also performed through telephone inquiry). Of the 47 patients, 3 (6%) had flap failure and 1 (2.1%) had partial flap necrosis. The hemiglossectomy group had better results than the total glossectomy group with respect to speech and diet, but neither of these results reached statistical significance ( = 1.0 for speech and = 0.06 for diet). The results of the subtotal glossectomy group were better than those of the total glossectomy group with respect to diet ( = 0.03). No statistically significant differences were noted among the three groups with respect to cosmetic aspect ( = 0.64). Considering its reasonable postoperative complication rates and functional results, peroneal flap can be considered a feasible option for tongue reconstruction.

Obliquely‐arranged double skin paddles: A novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap

“…Because multiple perforators could be usually found in the lateral lower leg, a double‐paddle peroneal flap could be easily harvested (Yang et al, ). With its relative thinness compared to antero‐lateral thigh flap (Hsu et al, ), the peroneal flaps could be easily reshaped into desirable shapes, such as acute‐angle mouth angle (Liu & Yang, ), hemiglossectomy defect (Lin, Liu, Lin, Chen, & Yang, ), hypopharyngeal defect (Lin et al, ), or extensive lip reconstruction (Lin, Liu, Lin, Chen, Hsueh et al, ). The novelty of this report is that we refine our design to maximize the area of skin paddle we could harvest.…”

“…In this report, we would like to introduce a novel design of using the obliquely‐arranged double skin paddles to maximize the harvested skin area of lateral lower leg. The design can be applied to fibula flap, or peroneal flap which is the boneless version of fibula flap (Lin, Liu, Chen, & Yang, ; Lin, Liu, Lin, Chen, & Yang, ; Lin, Liu, Lin, Chen, Hsueh et al, ; Liu & Yang, ; Wolff, ; Yang, Leung, & Chen, ). Herein, we present a series of eight cases with extensive through and through defects reconstructed with single fibula or peroneal flap.…”

Long-term patient-reported donor-site morbidity after free peroneal fasciocutaneous flap in head and neck reconstruction

“…The peroneal flap is a reliable choice in complex head and neck reconstructive surgeries. [2][3][4][5][6] Issues regarding donor-site morbidity with peroneal flaps compared with other fasciocutaneous flaps, such as the anterolateral thigh flap or RFFF, are constantly debated among reconstructive surgeons. We used a patient-reported questionnaire rather than objective instrumental analysis because patient-reported outcomes can more accurately reveal the level of discomfort and impact of donor-site morbidities on patients' daily lives.…”

“…The peroneal flap and RFFF are two types of fasciocutaneous flaps that are frequently used for complex reconstruction after tumor ablation in head and neck cancer because of their thin and pliable skin paddles. 2 – 6 Compared with the RFFF, peroneal flap harvest has several advantages, such as the ability of a simultaneous approach by two surgical teams; larger skin paddles; more reliable perforators, which makes separate skin paddles feasible for reconstructing complex defects; 6 , 38 and adding the FHL muscle to achieve better results without a marked increase in donor-site morbidity, when this procedure is necessary. 37 , 39 However, donor scar aesthetics is a constant concern regarding these two flaps.…”

“…1 At our institute, peroneal flaps (fasciocutaneous or myofasciocutaneous flap) have been standard for reconstructing soft tissue defects after ablative surgery, such as tongue and esophageal defects that require thin and pliable flaps, or through-and-through defects involving the mouth angle and lips that require complex designs and reliable multiple perforators. [2][3][4][5][6] In other institutes, the radial forearm free flap (RFFF) and medial sural artery perforator (MSAP) flap have been alternatives for defects that require a thinner and more pliable flap. However, we prefer the peroneal flap for several reasons.…”