Peir-Rong Chen

The proximal lateral lower leg perforator flap revisited: Anatomical study and clinical applications

The proximal lateral lower leg flap is a flap suited for the reconstruction of small and thin defects. The purpose of this study was to map the position and consistency of the perforator vessels and to review its reliability and technical considerations clinically.

A comparison between proximal lateral leg flap and radial forearm flap for intraoral reconstruction.

AbstractFree flaps have become a popular option for the reconstruction of intraoral defects. The radial forearm flap used to be the workhorse flap for small and thin defects, but was associated with numerous donor-site morbidities. The proximal lateral leg flap can provide a thin and pliable tissue similar to the radial forearm flap but without the related donor-site morbidities. We compared the differences between these 2 flaps. Thirty-four patients with intraoral defects from September 2005 to October 2011 were reconstructed, using the radial forearm flap in 23 cases, and the proximal lateral leg flap in 11 cases. The radial forearm flap group had a success rate of 95.6%. The flap survival rate was 100% in the proximal lateral leg flap group. However, the difference was statistically insignificant. Skin graft was required in 22 of the 23 cases for the donor site of the radial forearm flap. Partial loss of the skin graft occurred in 5/22 (23%) of the patients, with exposure of tendons in 3/22 (14%). Delay in healing of the donor sites occurred in 6/23 (26%) of the patients. The donor sites of the proximal lateral leg flap were all closed primarily. One case developed wound dehiscence and this healed by conservative treatment. Long-term follow-up showed functional impairment of the donor forearm (reduced extension or grip strength) in 17% of the patients. Thirty percent of the patients developed sensory disturbance and 48% complained of poor outcome of the donor forearms. In the proximal lateral leg flap group, no motor or sensory functional deficits were seen. No patients complained of poor outcome of the donor legs. Primary closure of the donor site of the proximal lateral leg flap could be performed if the flap width was less than 6 cm. This flap is useful for patients with small and thin intraoral defects and is associated with minimal donor-site morbidity when compared to the radial forearm flap.

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

A Double-Skin Paddle Radial Forearm Flap for the Reconstruction of Oral Submucous Fibrosis

Objective: Oral submucous fibrosis can result in progressive restriction of mouth opening. Surgical treatment is indicated for severe cases. An innovative technique, a double-skin paddle radial forearm flap, using only one forearm donor site to reconstruct the bilateral buccal defects, is described. Patients and Methods: A total of six patients, having severe oral submucous fibrosis, were treated between July 2002 and August 2004. The surgical procedure consists of (1) release of all the intraoral fibrotic tissue, (2) masticatory muscle myotomy and coronoidotomy, and (3) reconstruction with a double-skin paddle radial forearm flap. Results: The preoperative mouth opening was 2 to 5 mm (mean: 3.3 mm). The intraoperative mouth opening ranged from 13 to 20 mm (mean 16.5 mm) after submucous release and ranged from 32 to 42 mm (mean 35.5 mm) after further release via myotomy and coronoidotomy. The proximal flap incorporated one perforator in two patients and two perforators in the remaining 4 patients. The size of the flaps ranged from 8 to 9 cm in length and 2 to 2.5 cm in width. Five flaps survived uneventfully. Arterial thrombosis, developing 24 hours after the operation, was noted in one flap. The flap was successfully salvaged after emergent exploration. Temporomandibular joint subluxation developed in one patient and required surgical reduction. One patient needed flap revision due to bulkiness. The postoperative mouth-opening range was 22 to 37 mm (mean: 30 mm) at an average follow-up period of 19 months. The average increase of the mouth opening was 26.7 mm, compared with the preoperative interincisor distance. Conclusion: Double-skin paddle radial forearm flap allowed simultaneous reconstruction of two separate buccal defects using a single donor site and thus obviates the need for a second free flap.

Using the Cephalic Vein Transposition as a Recipient Venous Drainage for Difficult Head and Neck Reconstructions

It is sometimes difficult to have a proper recipient vein for free tissue transfer in repeated or radiated head and neck reconstructions. The purpose of this article is to report our experience of using cephalic vein transpositions in difficult recipient beds in the necks. One hundred and nine free tissue transfers were performed for head and neck reconstruction in Buddhist Tzu Chi Medical Center between September 2000 and March 2003. Six cases without available recipient veins in the necks had used the cephalic vein transposition for drainage. The cephalic veins were dissected free from the upper limb for an adequate length and turned up to the neck as recipient veins for microvascular anastomoses with the pedicle veins of the free flaps. The incidence of using the cephalic vein transposition is 5.5%. All of the six free flaps survived and healed primarily. The reconstruction time was 390.33±28.77 minutes, which was similar to that of other patients (381.02±6.83) using neck veins. The cephalic vein transposition from the arm proves to be a reliable alternative recipient vein for microvascular head and neck reconstruction when there are no suitable veins in the necks.

Nonossifying Fibroma in the Mandible - A Case Report

Nonossifying fibroma usually occurs in the long bones of young people and is rarely seen in the other areas of the skeleton. A nonossifying fibroma in the mandible of a 27-year-old woman is described in this report. This patient had an asymptomatic swelling at the left mandibular angle for 5 years. The swelling enlarged abruptly with accompanying severe pain and tenderness due to contusion over her left cheek 5 days before this admission. Skull radiographs and computed tomographic scans revealed a large multilocular and well-demarcated radiolucent lesion at the left mandible. The lesion was removed by segmental resection of the mandible with immediate reconstruction using a free vascularized fibular bone graft. The final pathologic diagnosis was nonossifying fibroma. The postoperative course was smooth and the occlusion was good. Follow-up radiographs showed no evidence of recurrence and good union of the graft 10 months after surgery.