Wong Chin-Ho, Tan Bien-Keem, Wei Fu-Chan, Song Colin
Singapore and Taipei, Taiwan From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.
Plast Reconstr Surg. 2007 Nov;120(6):1576-1584. doi: 10.1097/01.prs.0000282076.31445.b4.
The skin paddle of the fibula osteoseptocutaneous flap is reliably vascularized by septocutaneous perforators from the peroneal artery. However, in 5 to 10 percent of lower limbs, these perforators are absent. This anatomical study evaluated use of the soleus musculocutaneous perforator for skin paddle salvage in such situations.
Latex injection studies were performed on 20 cadaveric lower limbs. The presence, prevalence, and location of the musculocutaneous perforators in the distal leg were documented. The perforators were traced proximally to determine their origins.
Of the 20 cadaveric limbs, one or more musculocutaneous perforators of at least 0.5 mm in diameter were noted in 18 specimens (90 percent). They were located within 6 cm of the junction of the middle and lower thirds of the fibula. The soleus musculocutaneous perforators originated in the peroneal artery in 10 specimens (50 percent), the posterior tibial artery in seven (35 percent), and the tibioperoneal trunk in one (5 percent). This information was successfully used to salvage the skin paddle in two of our clinical cases.
Use of the soleus musculocutaneous perforator depends on its origin. When it arises from the peroneal artery, a single set of anastomoses is all that is necessary for flap revascularization, with the skin paddle serving as a monitor for the bone flap. When it originates from the posterior tibial artery or tibioperoneal trunk, a second set of anastomoses is needed and the skin paddle cannot monitor the bone flap. The authors propose that one or two soleus musculocutaneous perforators be preserved during harvest until existence of the septocutaneous perforator is confirmed.
腓骨骨皮瓣的皮瓣由来自腓动脉的肌皮穿支可靠地供血。然而，在5%至10%的下肢中，这些穿支不存在。本解剖学研究评估了在这种情况下使用比目鱼肌皮穿支挽救皮瓣的情况。
对20具尸体下肢进行乳胶注射研究。记录小腿远端肌皮穿支的存在、发生率和位置。将穿支向近端追踪以确定其起源。
在20具尸体下肢中，18个标本（90%）发现了一条或多条直径至少0.5毫米的肌皮穿支。它们位于腓骨中、下三分之一交界处6厘米范围内。10个标本（50%）的比目鱼肌皮穿支起源于腓动脉，7个（35%）起源于胫后动脉，1个（5%）起源于胫腓干。这些信息成功用于挽救我们临床病例中的两例皮瓣。
比目鱼肌皮穿支的使用取决于其起源。当它起源于腓动脉时，皮瓣再血管化只需一组吻合，皮瓣可作为骨瓣的监测器。当它起源于胫后动脉或胫腓干时，则需要第二组吻合，且皮瓣不能监测骨瓣。作者建议在切取过程中保留一两条比目鱼肌皮穿支，直到确认存在皮穿支。
