Peroneal perforator flap for intraoral reconstruction

Wolff, Klaus; Bauer, Florian; Wylie, Jennifer; Stimmer, Herbert; Hölzle, Frank; Kesting, Marco

doi:10.1016/j.bjoms.2010.11.018

Cited by 29 publications

(18 citation statements)

References 18 publications

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“…As quoted in literature, we also felt the advantages of peroneal flap includes excellent pliable soft tissues, hidden scar, skin graft can be avoided in most cases and two team approach [8]. 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 [8]. Our patient had an arterial thrombus within few hours post-operatively which was successfully salvaged with immediate re-exploration and re-anastomosis of artery.…”

Section: Discussionmentioning

confidence: 69%

“…Location of perforators vary, hence pre operative localisation can be done by ultrasound doppler, CT angio or MR angiography. As quoted in literature, we also felt the advantages of peroneal flap includes excellent pliable soft tissues, hidden scar, skin graft can be avoided in most cases and two team approach [8]. 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 [8].…”

Section: Discussionmentioning

confidence: 86%

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Perforator Peroneal Artery Flap for Tongue Reconstruction

Chauhan

Chavre

Chandrashekar

et al. 2016

J. Maxillofac. Oral Surg.

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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 ...

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 86%

Perforator Peroneal Artery Flap for Tongue Reconstruction

Chauhan

Chavre

Chandrashekar

et al. 2016

J. Maxillofac. Oral Surg.

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“…Therefore, preoperative imaging of this anatomical highly variable region is mandatory (Yokoo et al, 2001;Ozalp et al, 2006;Wong et al, 2007;Yadav et al, 2009), and CTA gave all relevant information concerning the flap pedicle. As another option, MR angiography could also be used to assess the anatomy of the lower leg vessels, but this technique is unable to describe the course of the perforator and cannot provide complete imaging of the side branches up to the skin (Wolff et al, 2010). Thus, CTA best helps the surgeon to decide which perforator is the most suitable for soleus perforator flap raising.…”

Section: Discussionmentioning

confidence: 96%

Further experience with the free soleus perforator flaps using CT-angiography as a planning tool – A preliminary study

Wolff

Bauer

Dobritz

et al. 2012

Journal of Cranio-Maxillofacial Surgery

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“…10 To address this challenge, some have proposed using preoperative imaging studies to locate the branches and perforators of the peroneal artery. 15 However, radiographic imaging is unable to accurately predict the origin or demonstrate the deeper course of either septocutaneous branches or musculocutaneous perforators. 16,17 Therefore, the intraoperative visualization of the septocutaneous branches or musculocutaneous perforators is still considered the most crucial step for elevating a fibula osteocutaneous flap, and our group only uses CT angiography to The posterior approach of procuring the fibula flap skin paddle is advantageous from the standpoint of procuring a reliable skin paddle for many reasons.…”

Section: Discussionmentioning

confidence: 99%

Fibula Osteoseptocutaneous Flap

Chen

Qiu

Lin

et al. 2016

Annals of Plastic Surgery

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According to our experience, the posterior approach for the harvest of the osteoseptocutaneous fibula flap is a safe technique and offers many advantages, such as a better visualization of the perforators, beneficial for chimeric flap elevation, preservation of the muscular fascia in the donor site, and an earlier diagnosis of any anatomical variation. Both the reliable and the versatility of the skin paddle can substantially improve with this approach.

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Peroneal perforator flap for intraoral reconstruction

Cited by 29 publications

References 18 publications

Perforator Peroneal Artery Flap for Tongue Reconstruction

Perforator Peroneal Artery Flap for Tongue Reconstruction

Further experience with the free soleus perforator flaps using CT-angiography as a planning tool – A preliminary study

Fibula Osteoseptocutaneous Flap

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