A novel patient positioning technique during raising peroneal system free flaps

The purpose of this pictorial essay is to clarify and propose a novel positioning technique for raising the free flaps on the peroneal system with the aim of obtaining optimal exposure of the operating field, good stabilization of the inferior limb with high comfort for the surgical teams without the need of a third assistant during the harvest or closure. A review of the literature, focusing on the exact position of the patient during the harvest of the peroneal system flaps, was made and no key publications were found. In February 2007, the Maxillofacial group at the Bufalini Hospital of Cesena and the University of Sassari Hospital switched from putting the patient in a standard Gilbert’s technique with the use of a second assistant to a novel positioning technique in the supine position with the use of the orthopedic-derived supports in order to hold the leg during the harvest. A broad literature review was also performed, revealing very little literature on this topic. A shared guideline for standardized positioning of the patient in FFF harvesting can decrease the potential risk for gravitational-related injuries on the operating table and thus the legal complaints as well. We think that our novel positioning technique can be useful for all residents in maxillofacial, plastic and ENT Departments, improving the time spent in the operating room and for all the more skilled senior colleagues who carry out this type of intervention to facilitate their task and make it more comfortable. Level of evidence: level V, therapeutic study