Yadav Prabha S, Ahmad Quazi G, Shankhdhar Vinay K, Nambi G I
Plastic and Reconstructive Services, Department of Surgical Oncology, TATA Memorial Hospital, Parel, Mumbai, India.
Indian J Plast Surg. 2012 Jan;45(1):58-61. doi: 10.4103/0970-0358.96586.
The skin paddle of the free fibula flap receives its vascular supply from septocutaneous perforators, musculocutaneous perforators or from both, and these perforators might originate from the peroneal or posterior tibial vessels or from both. The objective of this study was to classify the skin paddles based on the dominance of vascular contribution by these axial vessels through their different perforator systems.
A retrospective analysis of 5-year data of 386 free fibula flaps used in oro-mandibular reconstruction was done and the skin paddle vascularity was studied. While majority of the skin paddles received their blood supply from the peroneal septocutaneous perforators, a few had their dominant supply from the soleus musculocutaneous perforators in addition to peroneal septocutaneous perforators. In few cases, the soleus musculocutaneous perforators were the sole source of blood supply to the skin paddle. The limitation in this study was the inability to augment the clinical observation with cadaveric study.
The skin paddle of the free fibula flap was classified into four different types (a-d) based on the dominance of vascular contribution by axial vessels of the leg.
The skin paddle of the free fibula flap has reliable blood supply, but a thorough knowledge of the variations in vascular pattern of the skin paddle is required especially to salvage the larger paddles used in the reconstruction complex oro-mandibular defects.
游离腓骨瓣的皮瓣由肌间隔皮穿支、肌皮穿支或两者供血，这些穿支可能起源于腓血管或胫后血管或两者。本研究的目的是根据这些轴型血管通过其不同穿支系统对皮瓣供血的优势对皮瓣进行分类。
对386例用于口腔颌面部重建的游离腓骨瓣5年的数据进行回顾性分析，并研究皮瓣的血管情况。虽然大多数皮瓣由腓骨肌间隔皮穿支供血，但少数皮瓣除了由腓骨肌间隔皮穿支供血外，还主要由比目鱼肌皮穿支供血。在少数情况下，比目鱼肌皮穿支是皮瓣供血的唯一来源。本研究的局限性在于无法通过尸体研究来补充临床观察。
根据小腿轴型血管对皮瓣供血的优势，将游离腓骨瓣的皮瓣分为四种不同类型（a - d）。
游离腓骨瓣的皮瓣血供可靠，但需要全面了解皮瓣血管模式的变异情况，尤其是在挽救用于重建复杂口腔颌面部缺损的较大皮瓣时。
