Summary
Background
Several different flaps can reconstruct intraoral defects or lower limb deficits after
free fibula osteo-cutaneous flap harvesting for jaw reconstructions. However, commonly
used options may not be available for various reasons and can be associated with significant
morbidity. We hypothesized that flaps supplied by the superficial peroneal nerve accessory
artery (SPNAA) could be a viable alternative reconstructive option.
Methods
We describe the SPNAA's anatomy using 20 human cadaveric leg dissections and report
eight cases involving SPNAA-based perforator flap reconstructions (six propeller flaps
and two free flaps) in a retrospective case series. Patient-specific baseline variables
and intraoperative and postoperative outcomes are described.
Results
Cadaveric dissection suggests that the location of the SPNAA is reliable but its origin
varies, with 40% (N = 8) of SPNAAs being of type I origin, 20% type II (N = 4), and 40% (N = 8) type III in our series. All reconstructions were successful. No intraoperative
complications occurred during propeller or free-flap reconstructions. No flap failures
occurred. One propeller reconstruction showed distal superficial skin necrosis and
one donor site wound dehisced; both were successfully managed conservatively. No other
short-term or long-term complications occurred.
Conclusions
Flaps based on SPNAA perforators appear effective, reliable, and safe reconstructive
methods for covering fibula osteocutaneous donor site defects and for intraoral reconstructions.
Controlled trials are required to compare its effectiveness and safety with other
reconstructive methods.
Keywords
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References
- Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap.J Plast Reconstr Aesthet Surg. 2008; 61: 934-938
- An anatomic study of the septocutaneous vessels of the leg.Plast Reconstr Surg. 1985; 76: 354-361
- Choosing the correct sense of rotation in 180° propeller flaps.J Plast Reconstr Aesthet Surg. 2008; 61: 1492
- A large genome-wide association study of age-related macular degeneration highlights contributions of rare and common variants.Nat Genet. 2016; 48: 134-143
- Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects.Plast Reconstr Surg - Glob Open. 2018; 6
- Sandwich fascial anterolateral thigh flap in head and neck reconstruction: evolution or revolution?.Plast Reconstr Surg - Glob Open. 2017; 5
- Medial lower leg perforators: an anatomical study of their distribution and characteristics.Microsurgery. 2017; 37: 319-326
- Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Br Med J. 2007; 335: 806-808
- Is the LICOXⓇ PtO2 system reliable for monitoring of free flaps? Comparison between two cohorts of patients.Microsurgery. 2019; 39: 423-427
- Tear drop-free anterolateral thigh flap, a versatile design for lower limb reconstruction after trauma.Microsurgery. 2018; 38: 278-286
- An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps.Ann Plast Surg. 2008; 60: 710-716
- The anterior tibial artery flap: anatomic study and clinical application.Plast Reconstr Surg. 1987; 79: 396-404
- Vicryl hypersensitivity test with histological response.Dermatitis. 2016; 27: 145-146
- Ischemic damage of the flaps: new treatments.J Investig Surg. 2020; 33: 189-190
- Distally based saphenous nerve-greater saphenous venofasciocutaneous flap for reconstruction of soft tissue defects in distal lower leg.Ann Plast Surg. 2016; 77: 102-105
- Avoiding secondary skin graft donor site morbidity in the fibula free flap harvest.Arch Otolaryngol - Head Neck Surg. 2008; 134: 1324-1327
- Vascular anatomy and clinical application of anterolateral leg perforator flaps.Plast Reconstr Surg. 2013; 131
Schünemann H., Brożek J., Guyatt G., Oxman A. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. Updated October 2013. The GRADE Working Group, 2013. https://gradepro.org/cite/.
- A systematic review of validated tools assessing functional and aesthetic outcomes following fibula free flap reconstruction of the mandible.Head Neck. 2019; 41: 248-255
- Skin graft donor site: a procedure for a faster healing.Acta Biomed. 2017; 88: 310-314
- Role of negative pressure therapy as damage control in soft tissue reconstruction for open tibial fractures.J Reconstr Microsurg. 2017; 33: S8-S13
- The propeller flap method.Br J Plast Surg. 1991; 44: 53-54
- The 180-degree perforator-based propeller flap for soft tissue coverage of the distal, lower extremity: a new method to achieve reliable coverage of the distal lower extremity with a local, fasciocutaneous perforator flap.Ann Plast Surg. 2007; 59: 667-671
- Is the medial sural artery perforator flap a new workhorse flap? A systematic review and meta-analysis.Plast Reconstruc Surg. 2019; 143 (Lippincott Williams and Wilkins): 393e-403e
- Reconstruction of moderate-sized hand defects using a superficial lateral sural artery perforator flap.Ann Plast Surg. 2017; 78: 412-416
- Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: clinical applications and treatment of venous congestion.J Int Med Res. 2017; 45: 1074-1089
- Sural versus perforator flaps for distal medial leg wounds.Orthopedics. 2015; 38: e1059-e1064
- Anatomic basis of the gastrocnemius perforator-based flap.Ann Plast Surg. 2001; 47: 517-522
- Propeller flaps in the closure of free fibula flap donor site skin defects.Ann Plast Surg. 2013; 71: 76-79
- The free or pedicled saphenous flap.Ann Plast Surg. 1988; 21: 369-374
- The anterior tibialis artery perforator (atap) flap for traumatic knee and patella defects: clinical cases and anatomic study.Ann Plast Surg. 2010; 64: 210-216
- Microsurgical reconstruction in patients greater than 80 years old.Microsurgery. 2017; 37: 546-551
- Perforator flaps from the lower leg for intraoral reconstruction: experience of 131 flaps.J Cranio-Maxillofac Surg. 2018; 46: 338-345
Article Info
Publication History
Published online: November 21, 2020
Accepted:
November 12,
2020
Received in revised form:
October 30,
2020
Received:
April 28,
2020
Footnotes
Presentations: None.
Identification
Copyright
© 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
