Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2011 Aug;128(2):440-446. doi: 10.1097/PRS.0b013e31821e7058.
Designing a reliable fibula flap skin paddle can be challenging because of the lack of information on precise perforator locations. The purpose of this study was to precisely map the perforators and provide a simple and reliable method for skin paddle design.
Eighty consecutive patients undergoing free fibula flap reconstruction were included in this prospectively designed study. The location, size, and type of perforators were recorded intraoperatively and mapped on the line connecting the fibular head and lateral malleolus.
There were 46 male and 34 female patients with a total of 202 perforators. The average length of the fibular head and lateral malleolus line was 36.1 ± 3.4 cm (male patients, 38.2 ± 2.2 cm; female patients, 34.1 ± 2.7 cm). Two discrete groups of perforators could be identified. The proximal perforator was consistently found one-third the length and 1.5 cm posterior to the line. The majority of these perforators (84 percent) were musculocutaneous. The more clinically useful perforators to support a skin paddle are the distal ones over the third quarter of the fibula. One to three distal perforators were consistently present, grouped as perforators A, B, and C at points 0.51, 0.62, and 0.73 along the line, respectively. Perforators were approximately 3.5 cm apart and 2 cm posterior to the line, and the majority (96 percent) were septocutaneous.
Using common anatomical landmarks, a reliable skin paddle can be designed with simplicity and confidence over the third quarter of the fibula. The proximal perforator can be useful as a second skin paddle for through-and-through reconstruction.
由于缺乏关于确切穿支位置的信息，设计可靠的腓骨皮瓣皮瓣可能具有挑战性。本研究的目的是精确绘制穿支并提供一种简单可靠的皮瓣设计方法。
本前瞻性设计研究纳入 80 例连续接受游离腓骨皮瓣重建的患者。术中记录穿支的位置、大小和类型，并在连接腓骨头和外踝的线上进行映射。
46 名男性和 34 名女性患者共 202 个穿支。腓骨头和外踝线的平均长度为 36.1±3.4cm（男性患者为 38.2±2.2cm；女性患者为 34.1±2.7cm）。可识别出两组离散的穿支。近端穿支始终位于线的三分之一长度和后 1.5cm 处。这些穿支中的大多数（84%）为肌皮穿支。更具临床意义的支持皮瓣的穿支是腓骨的三分之一后段的远端穿支。始终存在 1 至 3 个远端穿支，分别在沿线上的 0.51、0.62 和 0.73 点分组为 A、B 和 C 穿支。穿支之间相隔约 3.5cm，位于线后 2cm，大多数（96%）为节段性皮穿支。
使用常见的解剖学标志，可以简单、自信地在腓骨的三分之一后段设计可靠的皮瓣。近端穿支可用作贯穿重建的第二个皮瓣。
