Winters H A, de Jongh G J
Department of Plastic and Reconstructive Surgery at the Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Plast Reconstr Surg. 1999 Mar;103(3):846-9. doi: 10.1097/00006534-199903000-00010.
The vascularization of the skin paddle of 20 osteocutaneous fibula free flaps in 20 patients was studied. All skin paddles were designed over the proximal and middle third of the fibula. A parallel vascularization of the skin was found in 10 cases. In these cases, an axial (septo)musculocutaneous perforator was found to originate high in the peroneal artery or even in the popliteal artery. This branch runs parallel to the peroneal artery without any further connections with it. In 5 of these 10 cases, no other skin perforators were located within the boundaries of the skin paddle. Harvesting such a flap in the traditional way by blind inclusion of a muscle cuff results in ligation of the supplying vessel of the skin paddle and subsequent loss of the skin. In this series, this would have been the case in 5 of the 20 patients (25 percent). This might explain the bad reputation of the skin paddle of this flap. The high prevalence of the described vascular configuration in a proximally designed skin paddle justifies à vue dissection of all musculocutaneous perforators up to their origin, unless one or more septocutaneous perforators are found within the boundaries of the flap.
对20例患者的20块游离腓骨骨皮瓣皮瓣的血管化情况进行了研究。所有皮瓣均设计在腓骨近端和中1/3段。10例发现皮瓣存在平行血管化。在这些病例中，发现一条轴型（间隔）肌皮穿支起源于腓动脉高位甚至腘动脉。该分支与腓动脉平行走行，与腓动脉无其他进一步连接。在这10例中的5例，皮瓣范围内未发现其他皮肤穿支。采用传统方法盲目包含肌肉袖套来切取这样的皮瓣会导致皮瓣供血血管结扎，进而导致皮肤坏死。在本系列中，20例患者中的5例（25%）会出现这种情况。这可能解释了该皮瓣皮瓣的不良声誉。近端设计的皮瓣中所述血管构型的高发生率证明，除非在皮瓣范围内发现一个或多个间隔皮穿支，否则应对所有肌皮穿支直至其起源进行直视下解剖。
