Sassu Paolo, Acland Robert D, Salgado Christopher John, Mardini Samir, Ozyurekoglu Tuna
Department of Hand and Reconstructive Microsurgery, Cagliari, Italy.
Ann Plast Surg. 2010 Feb;64(2):233-7. doi: 10.1097/SAP.0b013e3181a2c772.
Contracture as well as weakness of the flexor hallucis longus (FHL) are possible complications following free fibula flap harvest. Possible causes have been related to fibrotic change of the muscle either due to devascularization or compartment-like syndrome after a tight wound closure. This study elucidates the vascularization and nerve supply of the FHL muscle after fibula flap harvest in a fresh cadaver model.A fibula bone flap was harvested through a lateral approach in 20 fresh limbs. The popliteal artery was isolated and injected with a silicone compound, the muscle isolated, and its neurovascular supply visualized.The distal third and fourth portion of the FHL muscle was always found to be located in a more compressed and deeper compartment. The peroneal artery was entirely filled by the silicone compound in 17 fresh cadaver limbs with at least one branch supplying the distal fourth of the FHL. The posterior tibialis artery was filled in all limbs and an average of 2 branches was found to supply the muscle. In all dissections, the nerve supplying the FHL originated from the tibialis nerve with an average of three branches perforating the muscle.Following fibula harvest, the FHL muscle will maintain vascular supply through the distal portion of the peroneal artery and the posterior tibialis artery. Nerve injury to the FHL muscle is unlikely during flap harvest.
游离腓骨瓣切取术后可能出现拇长屈肌（FHL）挛缩及无力等并发症。可能的原因与肌肉因血运障碍导致的纤维化改变或伤口紧密闭合后的类似骨筋膜室综合征有关。本研究在新鲜尸体模型中阐明了腓骨瓣切取术后FHL肌肉的血管化及神经供应情况。通过外侧入路在20条新鲜肢体上切取腓骨骨瓣。分离腘动脉并注入硅化合物，分离肌肉并观察其神经血管供应情况。总是发现FHL肌肉的远端三分之一和四分之一部分位于更受压且更深的骨筋膜室内。在17条新鲜尸体肢体中，腓动脉完全被硅化合物充盈，且至少有一个分支供应FHL的远端四分之一。所有肢体的胫后动脉均被充盈，平均有2个分支供应该肌肉。在所有解剖中，供应FHL的神经起源于胫神经，平均有三个分支穿过该肌肉。腓骨切取术后，FHL肌肉将通过腓动脉远端和胫后动脉维持血供。在瓣切取过程中，FHL肌肉不太可能发生神经损伤。
