Chimeric Osteocutaneous Free Flap Solution to Variation in Vascular Anatomy.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Vascular Anatomy

Background:

• Mandibular resection for squamous cell carcinoma often results in complex defects.
• Osteocutaneous fibula free flaps are a common reconstructive method, typically relying on the peroneal artery for vascular supply to both bone and skin paddle.
• Variations in vascular supply can complicate free flap procedures.

Observation:

• Anatomical variation identified during fibula free flap harvest for mandibular reconstruction.
• The skin paddle's vascular supply originated from soleus musculocutaneous perforators of the posterior tibial artery.
• The fibula component was supplied by the peroneal artery.

Findings:

• Successful reconstruction was achieved by anastomosing the posterior tibial artery perforator vessels of the skin paddle to the distal peroneal vessels.
• The peroneal vessels were subsequently anastomosed to the left superior thyroid artery and internal jugular vein.
• Adequate blood flow was confirmed using an implantable Doppler signal.

Implications:

• This case highlights a successful management strategy for aberrant vasculature during fibula free flap harvest.
• The described technique offers a valuable approach for cases with absent septocutaneous perforators from the peroneal artery (5%-10% of the population).
• This method potentially reduces patient morbidity and the need for revision surgeries in complex head and neck reconstructions.