Wong Chin-Ho, Tan Bien-Keem
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore.
J Trauma. 2010 Aug;69(2):459-65. doi: 10.1097/TA.0b013e3181d8944e.
The ability to reliably include a skin paddle with the fibula osteoseptocutaneous (OSC) flap is crucial both from the perspective soft tissue reconstruction and flap monitoring. In this study, we describe a three-step approach to the harvest of the fibula OSC flap that is reliable and versatile.
Step 1 starts by exploring the posterior crural septum from the anterior incision of the skin island with the aim being to identify the septocutaneous vessels that will supply the skin. Step 2 proceeds from the posterior aspect of the skin island. The septocutaneous vessel is traced to its origin, and the peroneal artery is detached from flexor hallucis longus that covers the posterior aspect of the artery. Finally, step 3 entails detaching all muscles attached to the fibula from anteriorly and can be expediently completed as vessels supplying the skin component have already been secured.
This technique was used successfully in 52 flap harvests. Absent septal vessels was noted in 4% of cases. In both cases, musculocutaneous perforators arising from the soleus muscle was used to supply the skin component. In one case, the septocutaneous vessel was noted to arise from the posterior tibial artery. Flap harvest was successful in all cases.
The three-step approach allowed us to reliably harvest the fibula OSC flap. We were able to visualize the anatomy clearly with this technique, and this has enabled us to detect anomalous anatomy early on in the dissection. These were successfully managed by using musculocutaneous perforators to the skin island that would normally be cut.
从软组织重建和皮瓣监测的角度来看，可靠地将皮瓣包含在腓骨骨皮瓣（OSC）中至关重要。在本研究中，我们描述了一种可靠且通用的三步法来切取腓骨OSC皮瓣。
第一步从皮岛的前切口开始探查小腿后间隔，目的是识别供应皮肤的穿支血管。第二步从皮岛的后侧进行。追踪穿支血管至其起源，并将腓动脉从覆盖动脉后侧的拇长屈肌上分离。最后，第三步是从前侧分离所有附着于腓骨的肌肉，由于供应皮肤部分的血管已经妥善处理，这一步可以迅速完成。
该技术在52例皮瓣切取中成功应用。4%的病例中未发现间隔血管。在这两例中，采用比目鱼肌发出的肌皮穿支来供应皮肤部分。在1例中，穿支血管被发现起源于胫后动脉。所有病例皮瓣切取均成功。
三步法使我们能够可靠地切取腓骨OSC皮瓣。通过该技术我们能够清晰地观察解剖结构，这使我们能够在解剖早期发现异常解剖情况。通过使用通常会被切断的肌皮穿支来供应皮岛，这些异常情况得以成功处理。
