J Wound Manag Res.  2023 Feb;19(1):76-79. 10.22467/jwmr.2022.02334.

Complete Bony Segment Flap Failure without Skin Paddle Compromise in Fibular Free Flap: A Case Report of a Rare Early Complication

• Singh H
• Jain A
• Jain R
• Mahendru S
• Khazanchi RK

• KMID: 2540023
• DOI: http://doi.org/10.22467/jwmr.2022.02334

Abstract

The free fibula flap is sometimes associated with partial flap loss. A 62-year-old man with squamous carcinoma of the lower alveolus underwent anterior arch resection and reconstruction with a fibula osteocutaneous flap containing three bony segments. There were two perforators in the skin flap; the first perforator was proximal to the bony segments and the other perforator was at the level of the middle segment. Atherosclerosis was observed in the anastomotic vessels. During surgery, thrombosis occurred in the arterial anastomosis, but was revised before the operation was over. The patient’s early postoperative course was uneventful. In the second week, purulent discharge was observed from the drains. Flap exploration showed devascularization of bony segments and periosteum, but the skin paddle was viable. The peroneal vessel had thrombosed distal to the takeoff of the proximal perforator and the viable skin paddle perfused by proximal perforators falsely indicated the well-being of underlying bones. The de-vascularized bones and sloughed periosteum were removed at the time of exploration, after which the skin paddle was reoriented for coverage of the defect. The patient completed chemoradiation without any bony reconstruction afterwards. This is the only reported case of early total bony flap portion loss with a viable skin paddle in free fibula flap transfer.

Keyword

Free fibula; Perforator flap; Periosteum; Case reports