Microvascular Transfer of The Compound Dorsalis Pedis Skin Flap With Second Metatarsal for Mandible and Floor of Mouth Reconstruction



Microvascular Transfer of The Compound Dorsalis Pedis Skin Flap With Second Metatarsal for Mandible and Floor of Mouth Reconstruction


R. M. ZUKER

R. T. MANKTELOW





Perhaps one of the most significant contributions to head and neck reconstruction is the use of the free composite osteocutaneous flap (1, 2, 3, 4, 5, 6, 7, 8). The dorsalis pedis flap (9, 10), when used with the second metatarsal, can reconstruct not only the floor of the mouth but also up to 8 cm of the mandible itself with vascularized tissue.




FLAP DESIGN AND DIMENSIONS

With postoperative lingual swelling, the pedicle could be compromised seriously if its position were between the tongue and mandible. Thus, it is better to have the vascular pedicle external to the mandible. The most likely site of recipient vasculature is identified. Because the position of the vessels should be external to the mandible, it is best to use the contralateral foot. Routine angiography is not necessary if adequate independent dorsalis pedis and posterior tibial pulses are present.

The boundaries of the skin flap include the extensor retinaculum proximally, the interdigital web spaces distally, and 1 cm on either side of the extensor hallucis longus (medially) and extensor digiti quinti (laterally). The second metatarsal then lies beneath the central segment of the skin flap (see Fig. 207.2B).


OPERATIVE TECHNIQUE

The operation is carried out in three parts. The tumor (Fig. 207.1A) is resected along with the anterior segment of mandible. Usually, a lip-splitting approach is used (Fig. 207.1B). A radical neck dissection is often necessary, and the recipient vasculature is prepared on this side. We have used virtually all the branches of the external carotid artery to revascularize this flap. Usually, however, the superior thyroid or facial vessels, if available, are used. To assist in the mandibular reconstruction, the mandible that has been resected is measured on either side of the midline and its angle at the
anterior segment is estimated. A template of this resected segment may be useful in planning the osteotomy of the second metatarsal.

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Microvascular Transfer of The Compound Dorsalis Pedis Skin Flap With Second Metatarsal for Mandible and Floor of Mouth Reconstruction
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