Posterior tibial artery flap with an adipofascial extension: Clinical application in head and neck reconstruction with detailed insight into septocutaneous perforators and donor site morbidity.

Abstract

BACKGROUND The general aim of this study is to describe a new modification to the posterior tibial artery flap (PTAF) and its clinical application in head and neck reconstruction and to investigate the distribution of septocutaneous perforators (SP) of the posterior tibial artery (PTA). The specific aim of this study is to evaluate the effectiveness of this new modification to the PTAF and describe the flap survival rate and donor site morbidity. METHODS From November 2017 to August 2018, 85 consecutive patients underwent PTAF reconstruction of the head and neck region after tumor extirpation. All PTAFs were harvested with a long adipofascial extension, and donor site defects were closed with a triangularly shaped full-thickness skin graft (FTSG) harvested adjacent to the flap. Special consideration was given to the harvesting technique, distribution of the posterior tibial artery SP, flap outcomes and associated donor-site morbidity. RESULTS Flap survival was 100%. The number of SPs varied from 1 to 5 per leg, with a mean of 2.61(1.15), and the SP were mostly clustered in the middle and distal thirds of the medial surface of the leg. The prevalence of the presence of one, two, three, four and five SP per leg was 7%, 33%, 27%, 19%, and 14%, respectively. Total and partial skin graft loss at the donor site was reported in 2 and 6 patients, respectively, who were conservatively managed. There was no statistically significant difference when comparing the pre- and postoperative range of ankle movements (P >0.05). CONCLUSION This new modification to the PTAF allows for the incorporation of more SPs into the flap, omits the need for a second donor site to close the donor site defect, and provides sufficient tissue to fill the dead space after tumor resection and neck dissection.