Background: The osteomyocutaneous peroneal artery-based combined (OPAC) flap is a refinement of fibula osteoseptocutaneous flap, with the inclusion of partial soleus muscle based on an independent myocutaneous perforator.
Methods: Seventeen men underwent composite oromandibular reconstruction using an OPAC flap. Flaps were raised with 1 or 2 skin paddles and 2 to 3 bone segments. In 8 cases, a portion of soleus muscle was included.
Results: All flaps survived, but partial failure occurred in 2 cases (11.7%). At a mean follow-up of 25.3 +/- 19.4 months, 6 of 12 patients tolerated a regular diet, 5 a soft diet, and 1 a liquid diet. Speech was normal in 2 patients, intelligible in 4, and slurred in 6.
Conclusion: Advantages of the OPAC flap include a single donor site, 1 pair of recipient vessels, versatile 3-dimensional inset, adequate soft tissue augmentation, and better aesthetic and functional outcomes.