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CC BY-NC-ND 4.0 · Indian J Plast Surg 2013; 46(01): 134-137
DOI: 10.4103/0970-0358.113733
Case Report
Association of Plastic Surgeons of India

Retrograde vascularisation of fibula free flap in composite oro-mandibular reconstruction

G.I. Nambi
Plastic and Reconstructive Microvascular Services, Comprehensive Cancer Center, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu
,
M. Dhiwakar
Head and Neck Oncology Services, Comprehensive Cancer Center, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu
› Author Affiliations
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Publication History

Publication Date:
07 October 2019 (online)

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ABSTRACT

We present a case of composite oromandibular reconstruction with fibula free flap in which the vascularity to the flap was established in a retrograde direction through the distal end of the peroneal pedicle vessels. The flap was initially designed in such a way so as to anastomose with superior thyroid artery. However after initial good flow, the superior thyroid artery flow became insufficient. Therefore, an attempt was made to vascularise the flap by anastomosing the distal end of peroneal vessels with the facial artery and a tributary of the internal jugular vein so that the flap was perfused in a retrograde direction. This was successful and the retrograde flow was adequate to ensure flap survival. We believe this to be the first successful case of reverse vascular flow reported for composite oromandibular reconstruction with the fibula free flap.

KEY WORDS

Composite oromandibular defects - fibula free flap - oromandibular reconstruction - retrograde vascularisation
 
  • 1 Yadav PS, Ahmad QG, Shankhdhar VK, Nambi GI. Successful management of free osteocutaneous fibula flap with anomalous vascularity of the skin paddle. Indian J Plast Surg 2009;42:255-7.
  • 2 Yadav PS, Gazwan QA, Shankhdhar VK, Nambi GI. A simple and cost effective template for central segment reconstruction of mandible with free fibula flap. J Maxillofac Oral Surg 2010;9:256-60.
  • 3 Yadav PS, Ahmad QG, Shankhdhar VK, Nambi GI. There is no donor side specificity of fibula free flap for complex oromandibular reconstruction. Indian J Plast Surg 2010;43:177-80.
  • 4 Yadav PS, Ahmad QG, Shankhdhar VK, Nambi GI. Modified right-angled forceps for Gigli′s wire saw retrieval during osteotomy. Indian J Plast Surg 2011;44:160-1.
  • 5 Yadav PS, Ahmad QG, Shankhdhar VK, Nambi GI. Reconstruction of oncological oro-mandibular defects with double skin paddled-free fibula flap: A prudent alternative to double flaps in resource-constrained centres. J Cancer Res Ther 2012;8:91-5.
  • 6 Yadav PS, Ahmad QG, Shankhdhar VK, Nambi GI. Skin paddle vascularity of free fibula flap: A study of 386 cases and a classification based on contribution from axial vessels of the leg. Indian J Plast Surg 2012;45:58-61.
  • 7 Ahmad QG, Yadav PS, Shankhdhar VK, Nambi GI. Use of fibula pedicle as a composite interposition vascular graft to salvage large skin paddle with anomalous vascular supply. Eur J Plast Surg 2011;34:413-6.
  • 8 Lee MG, Minn KW. Distally based free flap using retrograde arterial flow. Plast Reconstr Surg 1999;104:2063-7.
  • 9 Minami A, Kato H, Suenaga N, Iwasaki N. Distally-based free vascularized tissue grafts in the lower leg. J Reconstr Microsurg 1999;15:495-9.
  • 10 Numajiri T, Sowa Y, Nishino K, Sugimoto K, Iwashina Y, Ikebuchi K, et al. Successful retrograde arterial inflow through a muscular branch in a free anterolateral thigh chimeric flap transfer. Microsurgery 2012;32:318-21.