Rodriguez Ivan E, Trinh Becky B, Deleyiannis Frederic W-B
Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus; Aurora.
Eplasty. 2018 Sep 20;18:e24. eCollection 2018.
The present report describes an alternative technique of using a flow- through, double-paddle, fibular, osteocutaneous free flap based on one perforator from the peroneal system and one perforator from the anterior tibial system for a through-and-through mandibular defect. The patient was a 65-year-old man who underwent a composite resection of the floor of the mouth, mandible, and chin pad due to recurrent oral cavity squamous cell carcinoma. The fibula was harvested with one posterior-lateral septal perforator from the peroneal system and with a second skin perforator from the anterior tibial system to perfuse a 15 × 14 cm skin island. The anterior tibial perforator was anastomosed to the distal end of the peroneal artery in a flow-through technique, and the area between the peroneal and tibial perforators was de-epithelialized to reconstruct separately the floor of mouth and cutaneous defects. Good inflow and outflow of both skin islands were noted at the end of the procedure, and the patient recovered successfully without any fistulas or donor site morbidity. Perforators from the anterior tibial system should be considered for large, through-and-through mandibular defects when using 2 perforators from the peroneal system is not possible. In addition, we believe the flow-through technique can be useful in patients with vessel-depleted necks and provides a suitable match for vessel size between an anterior tibial perforator and the distal end of the peroneal system.
本报告描述了一种替代技术，即使用基于腓骨系统的一个穿支和胫前系统的一个穿支的穿流式双叶腓骨骨皮游离皮瓣，用于贯通性下颌骨缺损。患者为一名65岁男性，因复发性口腔鳞状细胞癌接受了口腔底部、下颌骨和颏下区的联合切除术。腓骨采用腓骨系统的一个后外侧间隔穿支和胫前系统的第二个皮肤穿支进行切取，以灌注一个15×14cm的皮岛。采用穿流式技术将胫前穿支与腓动脉远端吻合，腓骨穿支和胫前穿支之间的区域去上皮化，分别重建口腔底部和皮肤缺损。手术结束时，两个皮岛均有良好的血流进出，患者成功康复，未出现任何瘘管或供区并发症。当无法使用腓骨系统的两个穿支时，对于大型贯通性下颌骨缺损，应考虑使用胫前系统的穿支。此外，我们认为穿流式技术对颈部血管条件差的患者可能有用，并且胫前穿支与腓骨系统远端的血管大小匹配合适。
