Anatomical Study and Clinical Application of the Chimeric Multiple Perforator Fibula Flap (CMPF)

• Grant number: 18/09504-5
• Support Opportunities: Scholarships abroad - Research
• Start date: August 01, 2018
• End date: July 31, 2019
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Guilherme Cardinali Barreiro
• Grantee: Guilherme Cardinali Barreiro
• Host Investigator: Mario Giulio Solari
• Host Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil
• Institution abroad: University of Pittsburgh (Pitt), United States

Abstract

Introduction: The fibular osteocutaneous flap is a free flap composed of a bony segment of the fibula, the fibular artery, and a cutaneous island. It is widely used for microsurgical reconstruction of defects of the mandible and soft tissues of the head and neck.The skin island of the distal third of the leg is the most commonly used because of the higher density of perforators found there. However, this site usually implies morbidity in the donor area, especially when primary closure is not possible, such as pain, recurrent ulcer, instability and paresthesia.In addition, the osteocutaneous fibular flap is generally insufficient for complex and extensive reconstructions in the head and neck region, and the use of other free or pedicled flaps for filling and covering soft parts is routine.To optimize the use of the leg as a donor area, based on the fibular vessels, the use of proximal skin perforators and the solear muscle would produce a versatile fibular osteomyocutaneous chimeric flap for three-dimensional reconstructions. This approach would allow a greater possibility of primary closure of the donor area, or grafting in a more favorable topography; use of multiple perforators with multiple skin islands of larger extensions, and inclusion of part of the soleus muscle; allowing the use of a single flap to cover extensive and complex defects in the head and neck region and minimizing the commitment of the donor area.Objective: Through cadaver dissections, we intend to describe the unpublished chimeric osteomyocutaneous flap of the fibula with multiple cutaneous perforators, with subsequent clinical application in patients submitted to complex oncological resections of the head and neck.Results: We hope to develop a chimeric flap composed of several types of tissues, such as bone, skin and muscle, that have their individual components in perforators originating from a single main fibular pedicle. This would confer versatility, volume and cutaneous extension suitable for complex three-dimensional reconstructions in the head and neck region, using single flap and lower donor area morbidity.