Parascapular and free fibula flaps

1. Parascapular flap

2. Anatomy

10. • pedicle length of 6-10cm
• 10-14cm of bone can be obtained with a
width of 2–3cm
• skin island of up to 10cm x 30cm
• If the width of skin is more than 10cm, skin
grafting is required
• Calliber from 2 to 4 millimeters

11. Technique
• Lateral decubitus
• Arm free
• Marking
• Inferior dissection
• superficial to the deep fascia overlying the
muscles of shoulder
• Pedicle at superior border of the teres major
• Superior dissection

12. Advantages
• free-tissue transfers for large cheek defects
• reliability,
• appropriate bulk for the cheek
• lack of atrophy
• excellent contour
• Composite flap

13. Disadvantages
• Dissection of vascular pedicle can be tedious
because of numerous muscular and bony
branches that must be divided
• Donor site does not have a cutaneous sensory
nerve, and there is no possibility for a sensate
flap
• closure of the donor site
• color mismatch

14. Free fibula osteocutaneous flap

15. Indications
Reconstruction of
• oromandibular and midface/maxillary defects;
• upper and lower limb long bones;
• the pelvis;
• joints

16. Advantages
• Large vessels
• Long vascular pedicle
• Well vascularised bone
• Long length of donor bone (>25cm)
• Adequate bone stock
• Bony strength permits good screw fixation
and solid reconstruction
• Bony reconstruction can be shaped
with multiple segmental osteotomies

17. • Stable bicortical osseointegrated dental
implant fixation is possible
• Thin, pliable overlying skin (usually)
• Skin island adequate for most head and
neck reconstructions
• Very little soft tissue bulk (usually)
• Simultaneous cancer resection and harvesting
of flap possible

18. Disadvantages
Donor site morbidity:
• Delayed wound healing
• skin graft loss especially following peroneal
tendon exposure;
• nerve injury;
• ankle instability;
• Pseudocompartment syndrome
• Muscle necrosis

19. Preoperative vascular problems:
• Peripheral vascular disease, venous
insufficiency,
• previous deep vein thrombosis,
• congenital absence of lower leg vessels
• Peronea magna

20. • Poor skin quality: Obesity, stasis and ischemia
• Previous lower limb trauma: Fractures,
vascular injury

21. Anatomy

22. Muscles encountered when raising a FFF
• Peroneus longus
• Peroneus brevis
• Extensor digitorum longus
• Tibialis posterior
• Soleus
• Flexor hallucis longus
(The muscles subsequently reattach to scar
tissue and the divided interosseous membrane

25. • Not sensate.
• Large caliber of 1.5 to 4 mm
• Two venae, usually similar in size to the artery
• The short pedicle can be made longer by
dissecting it free of the proximal fibula

26. Pre op
• Vascularity
• X rays