A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases

Tyng-Luen Roan, Chien-Chang Chen, Yen-Chen Yu, Jung-Hsien Hsieh, Shyue-Yih Horng, Hao-Chih Tai, Nai-Chen Cheng, Hsiung-Fei Chien, Yueh-Bih Tang

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures. Patients and methods Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design. Results The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period. Conclusion The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect. © 2013 Wiley Periodicals, Inc. Microsurgery 33:439-446, 2013. Copyright © 2013 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)439-446
Number of pages8
JournalMicrosurgery
Volume33
Issue number6
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Neck
Head
Mandible
Cheek
Skin
Perforator Flap
Fibula
Microsurgery
Blood Vessels
Neoplasms
Thrombosis
Arteries
Tissue Donors
Bone and Bones

Keywords

  • adult
  • artery thrombosis
  • article
  • cancer surgery
  • cheek
  • chimeric flap
  • clinical article
  • donor site
  • female
  • fibula graft
  • follow up
  • graft salvage
  • head and neck surgery
  • human
  • male
  • mandible
  • mouth cancer
  • postoperative complication
  • priority journal
  • skin defect
  • skull disease
  • soft tissue defect
  • surgical technique
  • vein thrombosis
  • wide excision
  • Adult
  • Carcinoma, Squamous Cell
  • Female
  • Fibula
  • Free Tissue Flaps
  • Head and Neck Neoplasms
  • Humans
  • Male
  • Mandibular Neoplasms
  • Middle Aged
  • Reconstructive Surgical Procedures
  • Skin Transplantation
  • Tissue and Organ Harvesting

Cite this

A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases. / Roan, Tyng-Luen; Chen, Chien-Chang; Yu, Yen-Chen; Hsieh, Jung-Hsien; Horng, Shyue-Yih; Tai, Hao-Chih; Cheng, Nai-Chen; Chien, Hsiung-Fei; Tang, Yueh-Bih.

In: Microsurgery, Vol. 33, No. 6, 2013, p. 439-446.

Research output: Contribution to journalArticle

Roan, T-L, Chen, C-C, Yu, Y-C, Hsieh, J-H, Horng, S-Y, Tai, H-C, Cheng, N-C, Chien, H-F & Tang, Y-B 2013, 'A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases', Microsurgery, vol. 33, no. 6, pp. 439-446. https://doi.org/10.1002/micr.22123
Roan, Tyng-Luen ; Chen, Chien-Chang ; Yu, Yen-Chen ; Hsieh, Jung-Hsien ; Horng, Shyue-Yih ; Tai, Hao-Chih ; Cheng, Nai-Chen ; Chien, Hsiung-Fei ; Tang, Yueh-Bih. / A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases. In: Microsurgery. 2013 ; Vol. 33, No. 6. pp. 439-446.
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title = "A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases",
abstract = "Background We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures. Patients and methods Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design. Results The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period. Conclusion The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect. {\circledC} 2013 Wiley Periodicals, Inc. Microsurgery 33:439-446, 2013. Copyright {\circledC} 2013 Wiley Periodicals, Inc.",
keywords = "adult, artery thrombosis, article, cancer surgery, cheek, chimeric flap, clinical article, donor site, female, fibula graft, follow up, graft salvage, head and neck surgery, human, male, mandible, mouth cancer, postoperative complication, priority journal, skin defect, skull disease, soft tissue defect, surgical technique, vein thrombosis, wide excision, Adult, Carcinoma, Squamous Cell, Female, Fibula, Free Tissue Flaps, Head and Neck Neoplasms, Humans, Male, Mandibular Neoplasms, Middle Aged, Reconstructive Surgical Procedures, Skin Transplantation, Tissue and Organ Harvesting",
author = "Tyng-Luen Roan and Chien-Chang Chen and Yen-Chen Yu and Jung-Hsien Hsieh and Shyue-Yih Horng and Hao-Chih Tai and Nai-Chen Cheng and Hsiung-Fei Chien and Yueh-Bih Tang",
note = "被引用次數:8 Export Date: 16 March 2016 CODEN: MSRGD 通訊地址: Horng, S.-Y.; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan; 電子郵件: handyang@ms36.hinet.net 參考文獻: Hidalgo, D.A., Fibular free flap: A new method of mandible reconstruction (1989) Plastic and Reconstructive Surgery, 84 (1), pp. 71-79; Fu-Chan Wei, Hung-Chi Chen, Chwei-Chin Chuang, Noordhoff, M.S., Fibular osteoseptocutaneous flap: Anatomic study and clinical application (1986) Plastic and Reconstructive Surgery, 78 (2), pp. 191-199; Schusterman, M.A., Reece, G.P., Miller, M.J., Harris, S., The osteocutaneous fibular flap: Is the skin paddle reliable? (1992) Plast Reconstr Surg, 90 (5), pp. 787-793; Wei, F.-C., Celik, N., Chen, H.-C., Cheng, M.-H., Huang, W.-C., Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects (2002) Plastic and Reconstructive Surgery, 109 (1), pp. 45-52; Balasubramanian, D., Thankappan, K., Kuriakose, M.A., Duraisamy, S., Sharan, R., Mathew, J., Sharma, M., Iyer, S., Reconstructive indications of simultaneous double free flaps in the head and neck: A case series and literature review (2012) Microsurgery., 32 (6), pp. 423-430; Chien, S.H., Hsu, H., Huang, C.C., Lee, C.Y., Chiu, C.H.M., Lin, C.M., Reconstruction of advance head and neck patients after tumor ablation with simultaneous multiple free flaps: Indications and prognosis (2012) Ann Plast Surg, 69 (6), pp. 611-615; Balasubramanian, D., Thankappan, K., Kuriakose, M.A., Duraisamy, S., Sharan, R., Mathew, J., Sharma, M., Iyer, S., Reconstructive indications of simultaneous double free flaps in head and neck: A case series and literature review (2012) Microsurgery, 32, pp. 423-430; Ersoy, B., S{\"o}nmez, A., Bayrami{\cc}li, M., Sternocleidomastoid region restoration with lateral hemisoleus muscle incorporated in free fibular flap for reconstruction of radical neck dissection and hemimandibulectomy (2011) Microsurgery, 31, pp. 401-403; Roan, T.L., Horng, S.Y., Hsieh, J.H., Tai, H.C., Chien, H.F., Tang, Y.B., New modified free chimeric fibular flap design for head and neck reconstruction (2012) Head Neck, , Jun 19 [Epub ahead of print]; Huang, Y.C., Leong, C.P., Pong, Y.P., Liu, T.Y., Kuo, Y.R., Functional assessment of donor-site morbidity after harvest of a fibula chimeric flap with a sheet of soleus muscle for mandibular composite defect reconstruction (2012) Microsurgery, 32 (1), pp. 20-25; Kuo, Y.R., Shih, H.S., Chen, C.C., Boca, R., Hsu, Y.C., Su, C.Y., Jeng, S.F., Wei, F.C., Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation (2010) Ann Plast Surg, 64 (6), pp. 738-742; Cheng, M.H., Saint-Cyr, M., Ali, R.S., Chang, K.P., Hao, S.P., Wei, F.C., Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defect (2009) Head Neck, 31, pp. 361-370",
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TY - JOUR

T1 - A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases

AU - Roan, Tyng-Luen

AU - Chen, Chien-Chang

AU - Yu, Yen-Chen

AU - Hsieh, Jung-Hsien

AU - Horng, Shyue-Yih

AU - Tai, Hao-Chih

AU - Cheng, Nai-Chen

AU - Chien, Hsiung-Fei

AU - Tang, Yueh-Bih

N1 - 被引用次數:8 Export Date: 16 March 2016 CODEN: MSRGD 通訊地址: Horng, S.-Y.; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan; 電子郵件: handyang@ms36.hinet.net 參考文獻: Hidalgo, D.A., Fibular free flap: A new method of mandible reconstruction (1989) Plastic and Reconstructive Surgery, 84 (1), pp. 71-79; Fu-Chan Wei, Hung-Chi Chen, Chwei-Chin Chuang, Noordhoff, M.S., Fibular osteoseptocutaneous flap: Anatomic study and clinical application (1986) Plastic and Reconstructive Surgery, 78 (2), pp. 191-199; Schusterman, M.A., Reece, G.P., Miller, M.J., Harris, S., The osteocutaneous fibular flap: Is the skin paddle reliable? (1992) Plast Reconstr Surg, 90 (5), pp. 787-793; Wei, F.-C., Celik, N., Chen, H.-C., Cheng, M.-H., Huang, W.-C., Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects (2002) Plastic and Reconstructive Surgery, 109 (1), pp. 45-52; Balasubramanian, D., Thankappan, K., Kuriakose, M.A., Duraisamy, S., Sharan, R., Mathew, J., Sharma, M., Iyer, S., Reconstructive indications of simultaneous double free flaps in the head and neck: A case series and literature review (2012) Microsurgery., 32 (6), pp. 423-430; Chien, S.H., Hsu, H., Huang, C.C., Lee, C.Y., Chiu, C.H.M., Lin, C.M., Reconstruction of advance head and neck patients after tumor ablation with simultaneous multiple free flaps: Indications and prognosis (2012) Ann Plast Surg, 69 (6), pp. 611-615; Balasubramanian, D., Thankappan, K., Kuriakose, M.A., Duraisamy, S., Sharan, R., Mathew, J., Sharma, M., Iyer, S., Reconstructive indications of simultaneous double free flaps in head and neck: A case series and literature review (2012) Microsurgery, 32, pp. 423-430; Ersoy, B., Sönmez, A., Bayramiçli, M., Sternocleidomastoid region restoration with lateral hemisoleus muscle incorporated in free fibular flap for reconstruction of radical neck dissection and hemimandibulectomy (2011) Microsurgery, 31, pp. 401-403; Roan, T.L., Horng, S.Y., Hsieh, J.H., Tai, H.C., Chien, H.F., Tang, Y.B., New modified free chimeric fibular flap design for head and neck reconstruction (2012) Head Neck, , Jun 19 [Epub ahead of print]; Huang, Y.C., Leong, C.P., Pong, Y.P., Liu, T.Y., Kuo, Y.R., Functional assessment of donor-site morbidity after harvest of a fibula chimeric flap with a sheet of soleus muscle for mandibular composite defect reconstruction (2012) Microsurgery, 32 (1), pp. 20-25; Kuo, Y.R., Shih, H.S., Chen, C.C., Boca, R., Hsu, Y.C., Su, C.Y., Jeng, S.F., Wei, F.C., Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation (2010) Ann Plast Surg, 64 (6), pp. 738-742; Cheng, M.H., Saint-Cyr, M., Ali, R.S., Chang, K.P., Hao, S.P., Wei, F.C., Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defect (2009) Head Neck, 31, pp. 361-370

PY - 2013

Y1 - 2013

N2 - Background We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures. Patients and methods Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design. Results The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period. Conclusion The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect. © 2013 Wiley Periodicals, Inc. Microsurgery 33:439-446, 2013. Copyright © 2013 Wiley Periodicals, Inc.

AB - Background We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures. Patients and methods Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design. Results The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period. Conclusion The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect. © 2013 Wiley Periodicals, Inc. Microsurgery 33:439-446, 2013. Copyright © 2013 Wiley Periodicals, Inc.

KW - adult

KW - artery thrombosis

KW - article

KW - cancer surgery

KW - cheek

KW - chimeric flap

KW - clinical article

KW - donor site

KW - female

KW - fibula graft

KW - follow up

KW - graft salvage

KW - head and neck surgery

KW - human

KW - male

KW - mandible

KW - mouth cancer

KW - postoperative complication

KW - priority journal

KW - skin defect

KW - skull disease

KW - soft tissue defect

KW - surgical technique

KW - vein thrombosis

KW - wide excision

KW - Adult

KW - Carcinoma, Squamous Cell

KW - Female

KW - Fibula

KW - Free Tissue Flaps

KW - Head and Neck Neoplasms

KW - Humans

KW - Male

KW - Mandibular Neoplasms

KW - Middle Aged

KW - Reconstructive Surgical Procedures

KW - Skin Transplantation

KW - Tissue and Organ Harvesting

U2 - 10.1002/micr.22123

DO - 10.1002/micr.22123

M3 - Article

VL - 33

SP - 439

EP - 446

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 6

ER -