Deering Augustine J, Harrah Payden A, Won Brian Wong, Austin John Michael, Khan Mustafa T, Ferrell Jay K, Fries C Anton
From the Division of Plastic and Reconstructive Surgery, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX.
Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX.
Plast Reconstr Surg Glob Open. 2025 Jan 16;13(1):e6443. doi: 10.1097/GOX.0000000000006443. eCollection 2025 Jan.
When squamous cell carcinoma necessitates mandibular resection, the resultant defect can be complex. An osteocutaneous fibula free flap is an effective reconstruction option, typically supplied by the peroneal artery for both the fibula and skin flap. In this case report, an anatomical variation was found: the skin paddle was supplied by soleus musculocutaneous perforators of the posterior tibial artery, whereas the fibula was supplied by the peroneal artery. The posterior tibial artery perforator vessels from the skin paddle were anastomosed to the distal end of the peroneal vessels. The peroneal vessels were anastomosed to the left superior thyroid artery and a branch of the internal jugular vein, with confirmation of adequate blood flow via implantable Doppler signal. Septocutaneous perforators from the peroneal artery are absent in 5%-10% of the population; thus, an approach to anomalous vasculature in the setting of fibula free flap harvest that decreases morbidity and multiple operations is valuable.
当鳞状细胞癌需要进行下颌骨切除时，所产生的缺损可能很复杂。游离腓骨骨皮瓣是一种有效的重建选择，通常由腓动脉同时为腓骨和皮瓣供血。在本病例报告中，发现了一种解剖变异：皮瓣由胫后动脉的比目鱼肌皮穿支供血，而腓骨由腓动脉供血。来自皮瓣的胫后动脉穿支血管与腓血管的远端吻合。腓血管与左甲状腺上动脉和颈内静脉的一个分支吻合，并通过植入式多普勒信号确认血流充足。腓动脉的隔皮穿支在5%-10%的人群中不存在；因此，在游离腓骨瓣切取过程中处理异常血管系统的方法，若能降低发病率并减少多次手术，是很有价值的。
