Intraoral Reconstruction with “Thinned” Peroneal Artery Perforator Flaps: An Alternative to Classic Donor Areas in Comorbid Patients

Introduction: Free fasciocutaneous flaps are extensively used for intraoral soft tissue reconstruction. The free radial forearm flap (RFFF), offers thin, pliable skin with long vessels of high caliber, and historically, has been the most commonly used option for small soft tissue defects of the intraoral cavity. Recently, the anterolateral thigh (ALT) flap has come forward for intraoral soft tissue reconstruction. However, certain conditions exist where use of either flap is either not warranted or available.

Methodology and Material: We report two cases of intraoral reconstruction, where one patient had advanced scleroderma with tight forearm skin and the other with a history of Reynaud’s disease precluding the use of RFFF. In addition both patients had morbid obesity affecting the thigh region, and thus ALT flap was also not a suitable option.

Results: A peroneal artery perforator (PAP) flap was chosen. The flap was modified by “thinning” to achieve a more pliable flap that is more suitable for intraoral reconstruction. Both patients had good functional outcomes.

Conclusions: “Thinned” PAP flap is a unique and novel application that can safely be used even in obese patients when other alternatives are not available and when the lateral leg skin is too thick.