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Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures.
Laryngoscope. 2014 Jun; 124(6):1336-43.L

Abstract

OBJECTIVES/HYPOTHESIS

The purpose of this study was to analyze our experience with the composed double skin paddle fibula free flap to reconstruct large mandibulofacial defects.

STUDY DESIGN

Between 2006 and 2011, a total of 32 composed double skin paddle fibula free flap procedures were performed on 32 patients (mean age 54.4 ± 9.7 years, mean follow-up period of 3.4 ± 1.7 years).

METHODS

A chart review was drawn up to determine the type of defects covered by each skin paddle, the vascular anatomy, the origin of the perforators, and any associated complications.

RESULTS

The distal septocutaneous skin paddle (Nakajima type B) was used for the reconstruction of the floor of the mouth in most cases. The proximal paddle (Nakajima type D) was used for base of the tongue, mobile tongue, soft palate, internal cheek, inferior lip, and the skin of the chin and neck. The lateral soleus pedicle arose from the fibular pedicle in 28 cases and directly from the tibial-fibular trunk in four cases. There were two partial soleus skin paddle losses. Seven complications required revision surgery: due to a cervical abscess in two cases, due to a hematoma in two cases, due to a disunion of the second skin paddle leading to an orostoma in two cases, and due to an exposition of the osteosynthesis material in one case.

CONCLUSION

In large mandibulofacial defects, a second skin paddle raised on the soleus perforators may be of benefit when reconstructing the soft palate, neck, cheek, or tongue as the length of its pedicle renders a second free flap unnecessary.

LEVEL OF EVIDENCE

IV.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Institut Gustave Roussy, 94805, Villejuif Cedex, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

24352813

Citation

Leclère, Franck M., et al. "Reconstruction of Large Mandibulofacial Defects With the Composed Double Skin Paddle Fibula Free Flap: a Review of 32 Procedures." The Laryngoscope, vol. 124, no. 6, 2014, pp. 1336-43.
Leclère FM, Bosc R, Temam S, et al. Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures. Laryngoscope. 2014;124(6):1336-43.
Leclère, F. M., Bosc, R., Temam, S., Leymarie, N., Mirghani, H., Sarfati, B., & Kolb, F. (2014). Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures. The Laryngoscope, 124(6), 1336-43. https://doi.org/10.1002/lary.24452
Leclère FM, et al. Reconstruction of Large Mandibulofacial Defects With the Composed Double Skin Paddle Fibula Free Flap: a Review of 32 Procedures. Laryngoscope. 2014;124(6):1336-43. PubMed PMID: 24352813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures. AU - Leclère,Franck M, AU - Bosc,Romain, AU - Temam,Stéphane, AU - Leymarie,Nicolas, AU - Mirghani,Haitham, AU - Sarfati,Benjamin, AU - Kolb,Frédéric, Y1 - 2013/12/18/ PY - 2013/06/05/received PY - 2013/09/03/revised PY - 2013/09/23/accepted PY - 2013/12/20/entrez PY - 2013/12/20/pubmed PY - 2014/7/22/medline KW - Nakajima classification KW - Perforator flap KW - double skin paddle fibula free flap KW - fibula flap SP - 1336 EP - 43 JF - The Laryngoscope JO - Laryngoscope VL - 124 IS - 6 N2 - OBJECTIVES/HYPOTHESIS: The purpose of this study was to analyze our experience with the composed double skin paddle fibula free flap to reconstruct large mandibulofacial defects. STUDY DESIGN: Between 2006 and 2011, a total of 32 composed double skin paddle fibula free flap procedures were performed on 32 patients (mean age 54.4 ± 9.7 years, mean follow-up period of 3.4 ± 1.7 years). METHODS: A chart review was drawn up to determine the type of defects covered by each skin paddle, the vascular anatomy, the origin of the perforators, and any associated complications. RESULTS: The distal septocutaneous skin paddle (Nakajima type B) was used for the reconstruction of the floor of the mouth in most cases. The proximal paddle (Nakajima type D) was used for base of the tongue, mobile tongue, soft palate, internal cheek, inferior lip, and the skin of the chin and neck. The lateral soleus pedicle arose from the fibular pedicle in 28 cases and directly from the tibial-fibular trunk in four cases. There were two partial soleus skin paddle losses. Seven complications required revision surgery: due to a cervical abscess in two cases, due to a hematoma in two cases, due to a disunion of the second skin paddle leading to an orostoma in two cases, and due to an exposition of the osteosynthesis material in one case. CONCLUSION: In large mandibulofacial defects, a second skin paddle raised on the soleus perforators may be of benefit when reconstructing the soft palate, neck, cheek, or tongue as the length of its pedicle renders a second free flap unnecessary. LEVEL OF EVIDENCE: IV. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/24352813/Reconstruction_of_large_mandibulofacial_defects_with_the_composed_double_skin_paddle_fibula_free_flap:_a_review_of_32_procedures_ L2 - https://doi.org/10.1002/lary.24452 DB - PRIME DP - Unbound Medicine ER -