Anatomical study and clinical applications of the free posterior tibial flap in the head and neck region

Abstract

BACKGROUND: To study the anatomical features, clinical applications and the donor site morbidities of the free posterior tibial flap. METHODS: The posterior tibial vascular system was examined on 30 fresh cadaver legs. This was followed by a clinical study involving patients with free posterior tibial flap reconstruction of defects in the head and neck region after tumour extirpation. Potential donor site morbidities were studied at 1 year after surgery. RESULTS: The mean caliber of the posterior tibial artery and the venae comitantes in the cadaveric limbs were 2.7, 2.9 and 2.17 mm, respectively. The mean numbers of septocutaneous perforators were 2.85 per leg, clustering in the middle and distal thirds of the medial surface of the leg. The mean thickness of the skin and subcutaneous fat in the region was 4.43 mm. In the clinical study, 64 patients with superficial cutaneous and mucosal defects were recruited. Majority of the patients had carcinoma of the oral cavity. All flaps survived. Three (4.7%) patients developed mild infection of the donor site. None of the patients have problem walking on level ground. There was no significant reduction in the range of ankle movement, nor was there evidence of vascular compromise of the lower limb, both at rest and after exercise. CONCLUSIONS: The free posterior tibial flap is reliable because of its constant vascular anatomy. It is thin and pliable, making it particularly suitable for resurfacing superficial cutaneous and mucosal defects. Although skin graft is required to repair the donor site, the associated morbidity is low.