Hölzle Frank, Ristow Oliver, Rau Andrea, Mücke Thomas, Loeffelbein Denys J, Mitchell David A, Wolff Klaus-Dietrich, Kesting Marco Rainer
Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany.
Br J Oral Maxillofac Surg. 2011 Jun;49(4):270-4. doi: 10.1016/j.bjoms.2010.05.002. Epub 2010 Jun 15.
Perfusion of a fibular flap is based on the peroneal artery. To avoid ischaemia of the lower leg postoperatively after the artery has been sacrificed, adequate perfusion must be guaranteed preoperatively. Although common anatomical variations and pathological changes are well recognised, the best way to evaluate the vascular system preoperatively is controversial. Our aim was to identify anatomical vascular patterns that may jeopardise either the limb or the flap while the fibula is being harvested, and provide a few simple rules for the assessment of preoperative evaluation techniques. We dissected 128 lower legs preserved in formalin and evaluated them for the incidence of vascular anatomical variants. In addition we measured absolute and relative loss of volume. Volume loss from the peroneal artery was considerable, with a loss of 23%. On two occasions the peroneal artery mimicked the anterior tibial artery in its course to the dorsalis pedis artery at the dorsum of foot; four times the tibial artery arose directly from the peroneal artery; and five times only a rudimentary posterior tibial artery could be found. There are numerous vascular variants in the lower leg, some of which could put the flap or the limb at risk. We therefore think that preoperative evaluation of the vascular system is advisable.
腓骨瓣的血供基于腓动脉。为避免在牺牲该动脉后小腿术后出现缺血，术前必须确保充足的血供。尽管常见的解剖变异和病理变化已广为人知，但术前评估血管系统的最佳方法仍存在争议。我们的目的是识别在切取腓骨时可能危及肢体或皮瓣的解剖血管模式，并为术前评估技术的评估提供一些简单规则。我们解剖了128条用福尔马林保存的小腿，并评估了血管解剖变异的发生率。此外，我们测量了绝对和相对体积损失。腓动脉的体积损失相当大，损失率为23%。有两次，腓动脉在向足背的足背动脉走行过程中与胫前动脉相似；有四次，胫动脉直接发自腓动脉；有五次仅发现一条发育不全的胫后动脉。小腿存在众多血管变异，其中一些可能使皮瓣或肢体处于危险之中。因此，我们认为术前评估血管系统是可取的。
