Introducing the Tibial-Dorsalis Pedis Osteocutaneous Shin Flap: A New Option for Oromandibular Reconstruction

Abstract

Objectives:

The authors investigate the possibility of incorporating a well vascularized, partial corticotomy of the anterolateral aspect of the tibia in-series with a dorsalis pedis fasciocutaneous free flap for oromandibular reconstruction.

Methods:

The study consisted of three components. A cadaveric perfusion study was performed to characterize the vascular territory of the anterior tibial artery in regard to the surrounding osseous and soft tissue. A two-point breaking strength of the tibia was examined with fracture strain gauge analysis to determine the threshold of tibia corticotomy that would lead to a pathological fracture. Finally, the authors performed an in-vivo prospective clinical examination of the tibial-dorsalis pedis osteocutaneous shin flap.

Results:

The perfusion study revealed that the anterior tibial artery provided a rich matrix of myofascial periosteal blood supply to the anterolateral cortex of the tibia that could support free osseous tibial transfer. Two-point osteotomy fracture strain gauge analysis demonstrated that the threshold of tibia corticotomy that would lead to fracture of the remaining tibia was 30%. The osteocutaneous shin flap was performed in eight patients for recurrent, radiation failure, oral cavity T4 squamous cell carcinomas. The mean follow-up was 61 months. There were no cases of flap loss, salivary fistula, nonunion, or tibia pathologic fracture. All patients achieved ambulation.

Conclusions:

The authors introduce the osteocutaneous tibial-dorsalis pedis free vascularized flap as a viable option for oromandibular reconstruction. Its most notable advantage is the independent mobility of the skin paddle, in combination with an osseous reconstruction of the mandibular arch that facilitates primary osseointegration or denture rehabilitation.