ePlasty: Vol. 18
Utility of an Anterior Tibial Perforator for Skin Paddle Viability in Through-and-Through Defects of the Mandible
Ivan E. Rodriguez, MD, Becky B. Trinh, MD, and Frederic W-B Deleyiannis, MD, MPhil, MPH, FACS

Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus; Aurora

Correspondence: fred.deleyiannis@gmail.com
Keywords: fibular free flap, mandibular reconstruction, anterior tibial artery, flow-through technique, de-epithelialization

Objective: The present report describes an alternative technique of using a flow- through, double-paddle, fibular, osteocutaneous free flap based on one perforator from the peroneal system and one perforator from the anterior tibial system for a through-and-through mandibular defect. Methods: The patient was a 65-year-old man who underwent a composite resection of the floor of the mouth, mandible, and chin pad due to recurrent oral cavity squamous cell carcinoma. The fibula was harvested with one posterior-lateral septal perforator from the peroneal system and with a second skin perforator from the anterior tibial system to perfuse a 15 × 14 cm skin island. The anterior tibial perforator was anastomosed to the distal end of the peroneal artery in a flow-through technique, and the area bet .......