Outcome assessment of composite Oro-Mandibular Defect Reconstruction with Double Skin Paddle Free Fibula Osteocutaneous Flap
Abstract
Free fibular flap is the most favored free flap for composite defects of oro-mandibular region. Composite defects involving mucosa, mandible and skin often require two free flaps for the reconstruction. A technique of harvesting two separate cutaneous paddles of free fibular flap each based on a definite peroneal artery perforator was presented in this study. Reconstruction of composite oro-mandibular defect was done with two independent cutaneous paddles (proximal skin paddle based on musculo-cutaneous perforator and distal skin paddle based on septo-cutaneous perforator) in 12 patients. Post operative outcome was good, with 11 cases having no loss of skin paddle. There was an outer skin paddle necrosis in one patient for which cover was given with pectoralis major myocutanous flap. A double paddle free fibula flap can be used to reconstruct composite defects providing inner lining as well as skin cover with good flap success rates and better functional and aesthetic patient outcomes, thus avoiding an additional free or regional flap morbidity and decreased operative time.
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Introduction
Reconstruction of composite oro-mandibular defects continues to pose a challenge to the reconstructive surgeon. Large and composite defects in the head and neck region have better results with free flaps.1 Microsurgical reconstruction of composite through-and-through defects of the oral cavity involving mucosa, bone and external skin often requires two free flaps or de-epithelialization of the single cutaneous paddle of free fibular flap for successful functional and aesthetic outcomes.2 A safe, reliable technique using a double-skin paddle osteocutaneous free fibula flap to restore the intraoral lining, bony defect and external skin is described in literature. 2,3 The skin defect was reconstructed by a separate cutaneous paddle based on a consistent musculocutaneous perforator near the fibular head. An independent skin paddle allows better contouring and ease of insetting without any wastage of flap due to de- epithelialization. 2,3,4
This study was conducted to find out result of reconstruction of composite oro-mandibular defect was done with two independent cutaneous paddles in a tertiary care hospital of Rajasthan.
Conclusion
A consistent and reliable musculocutaneous perforator is present at approx. 12-14cm from the head of the fibula. An independent cutaneous paddle based on this perforator can be safely harvested along with the conventional skin paddle based on lower septocutaneous perforators. A double paddle free fibula flap can be used to reconstruct composite defects providing inner lining as well as skin cover with good flap success rates and better functional and aesthetic patient outcomes, thus avoiding an additional free or regional flap morbidity and thereby decreasing operative time.