Shanghai, People's Republic of China From the Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, JiaoTong University.
Plast Reconstr Surg. 2013 Sep;132(3):428e-437e. doi: 10.1097/PRS.0b013e31829ad16c.
The fibula flap has been widely used for reconstruction of composite bone and soft-tissue defects. The skin paddle of the fibula flap has played a critical role in providing a cutaneous component and good monitor for the bone component. In this report, the authors designed a perforator-based sural neurocutaneous flap instead of a peroneal perforator flap to enlarge a skin paddle for wound coverage.
A novel chimeric flap was harvested based on the peroneal artery, and consisted of a sural neurocutaneous flap and a fibular graft. The sural neurocutaneous flap was elevated based on a single peroneal perforator and connected with the bone component by means of the peroneal artery. Two patients with complex bone and soft-tissue defects were treated by using this chimeric flap. In case 1, the radius defect was 8 cm in length and the soft-tissue defect measured 23 × 10 cm. In case 2, the distal radius was injured and the defect was 16 cm in length. The area of soft-tissue defect was 23 × 8 cm. In this case, the fibula head was used for wrist reconstruction. The soft-tissue defects in the two cases stretched across the palmar and dorsal surfaces of the forearm.
The lengths of the bone components were 10 and 16.5 cm, respectively, and the areas of the skin components were 24 × 12 cm and 25 × 10 cm, respectively. Both chimeric flaps survived completely without complications. The follow-up period was 42 months in case 1 and 16 months in case 2. Complete bone union was observed in both cases, and no remarkable degeneration of the fibular head occurred in case 2. The sural neurocutaneous flap showed good texture match and contour. No serious donor-site complications occurred. The two patients were satisfied with their daily lives relative to the severity of their injuries.
The chimeric flap composed of a sural neurocutaneous flap and a fibular graft by means of the peroneal artery is a good candidate for reconstruction of long bone defects associated with extensive soft-tissue defects in the extremities.
腓骨皮瓣已广泛应用于重建复合骨和软组织缺损。腓骨皮瓣的皮瓣在提供皮肤成分和监测骨成分方面发挥了关键作用。在本报告中，作者设计了一种基于穿支的腓肠神经营养血管皮瓣，而不是腓动脉穿支皮瓣，以扩大皮瓣覆盖创面。
根据腓动脉设计了一种新型嵌合皮瓣，由腓肠神经营养血管皮瓣和腓骨移植物组成。腓肠神经营养血管皮瓣由单一腓动脉穿支提起，并通过腓动脉与骨成分相连。两名患有复杂骨和软组织缺损的患者接受了这种嵌合皮瓣治疗。在病例 1 中，桡骨缺损长 8cm，软组织缺损大小为 23×10cm。在病例 2 中，远端桡骨受伤，缺损长 16cm，软组织缺损面积为 23×8cm。在这种情况下，腓骨头用于腕关节重建。两个病例的软组织缺损横跨前臂掌侧和背侧表面。
骨成分的长度分别为 10cm 和 16.5cm，皮瓣成分的面积分别为 24×12cm 和 25×10cm。两个嵌合皮瓣均完全存活，无并发症。病例 1 的随访时间为 42 个月，病例 2 为 16 个月。两例均观察到完全骨愈合，病例 2 中腓骨头无明显退化。腓肠神经营养血管皮瓣质地和轮廓匹配良好。供区无严重并发症。两名患者对日常生活的满意度均与受伤严重程度有关。
由腓动脉供应的腓肠神经营养血管皮瓣和腓骨移植物组成的嵌合皮瓣是重建伴有四肢广泛软组织缺损的长骨缺损的良好选择。
