Clinical application of the free posterior tibial flap in the oral cavity

Abstract

INTRODUCTION: Over the years, the radial forearm flap has been the flap of choice for the repair of shallow intra-oral mucosal defects. However, it is notorious for the potential donor site morbidities. It would be advantageous for any flap which can provide similar tissue properties, while at the same time carry less donor site morbidity. This study reports our experience with the free posterior tibia (PT) flap for the reconstruction of such defects. METHODS: Dissection of the leg was performed in 30 cadaveric legs and the characteristics of the posterior tibia vascular system was noted and recorded. Subsequently the free posterior tibia flaps were used for reconstruction after resection of tumours in the oral cavity. Results of the reconstruction were noted. Post-operative wound healing was observed and the range of ankle movement as well as the vascular status of the lower limb was assessed by measuring the temperature, ankle-brachial index (ABI) and the capillary perfusion pressure 1 year after the operation. RESULTS: Our anatomical study showed that the flap is supplied by constant septocutaneous perforators arising from the posterior tibial artery in the medial distal third of the leg. The skin paddle taken from the region is both thin and supple. In our clinical study, 48 patients had PT flap reconstruction of the intra-oral defects after resection of tumours of the tongue (n = 32), buccal mucosa (n = 8), soft palate (n = 6) and the floor of mouth (n = 2). The success rate is 100%. Mild donor wound infection occurred in 4.2% of our patients. The aesthetic outcome of the donor site has been satisfactory. None of our patients have problems on walking after surgery. There was no statistically significant change in pre- and post-operative range of ankle movement as well as the vascular perfusion of the lower limb. DISCUSSION: The posterior tibial flap is a safe and versatile flap to be used clinically. Because the donor site morbidity is low, it has the potential to replace the radial forearm flap to resurface shallow intra-oral mucosal defects.