Hallock G G
Division of Plastic Surgery at Lehigh Valley Hospital, Allentown, PA, USA.
Plast Reconstr Surg. 1999 Sep;104(4):976-83. doi: 10.1097/00006534-199909040-00012.
The fibula has deservedly become a workhorse flap for vascularized bone grafts. As with most flaps, much is known regarding idiosyncrasies of its arterial supply, and the corresponding venous system has generally been assumed to be comparable. Because this donor site has become increasingly versatile, a detailed anatomic study that would verify this latter assertion should be important. Therefore, venous mapping specifically of the peroneal venae comitantes was completed in 29 fresh lower limbs. In every specimen, paired venae comitantes of large caliber indeed paralleled the course of the peroneal artery. All were of quality satisfactory for microanastomoses, which should provide reassurance that preoperative evaluation of the peroneal venous system is not routinely indicated. However, anatomic variations proved to be the norm. The two venae comitantes did not necessarily coalesce into a single common peroneal vein [6 of 29 (21 percent)]. Usually, the lateral peroneal vein was the larger and continued proximally either alone (17 percent) or as the common peroneal vein (66 percent) to form the lateral tibioperoneal vena comitans. Thus, the venous pedicle of a fibula flap could be lengthened up to its confluence with the popliteal vein, a maneuver that potentially could obviate the need for a vein graft at least on the venous side. Although anomalies of the peroneal artery could preclude use of the fibula altogether, there appeared to be no such contraindications from a venous standpoint, despite the fact that the venous anatomy was unique in every individual. Some important similarities in patterns, though, do exist. For example, a common peroneal vein was formed by the juncture of the lateral peroneal vein and some combination of branches joining the lateral posterior tibial vein and medial peroneal vein in 63 percent of all limbs. Because exceptions are the rule, the choice of donor vein and venous pedicle length best remains an intraoperative decision dependent on the presenting anatomy.
腓骨理所当然地成为了血管化骨移植的常用皮瓣。与大多数皮瓣一样，人们对其动脉供应的特点了解很多，并且通常认为相应的静脉系统与之相似。由于这个供区的用途越来越广泛，一项能够证实后一种说法的详细解剖学研究应该很重要。因此，对29条新鲜下肢进行了腓骨伴行静脉的专门静脉造影。在每个标本中，确实有一对大口径的伴行静脉与腓动脉走行平行。所有这些静脉的质量都足以进行显微吻合，这应该可以让人放心，不必常规进行腓骨静脉系统的术前评估。然而，解剖变异却是常态。两条伴行静脉不一定会合并成一条单一的腓总静脉[29例中有6例（21%）]。通常，外侧腓静脉较大，在近端单独延续（17%）或作为腓总静脉延续（66%），形成胫腓外侧伴行静脉。因此，腓骨皮瓣的静脉蒂可以延长至其与腘静脉汇合处，这一操作至少在静脉方面可能无需使用静脉移植。尽管腓动脉的异常可能会完全排除使用腓骨，但从静脉角度来看似乎没有这样的禁忌证，尽管事实上每个人的静脉解剖结构都是独特的。不过，在模式上确实存在一些重要的相似之处。例如，在所有下肢中，63%的情况下，外侧腓静脉与连接胫后外侧静脉和内侧腓静脉的一些分支组合相汇合形成腓总静脉。由于例外情况很常见，供体静脉的选择和静脉蒂长度最好仍由术中根据实际解剖情况决定。
