Barbera Federico, Lorenzetti Fulvio, Marsili Ricccardo, Ragoni Matteo, Lisa Andrea, Zampa Virna, Pantaloni Marcello
Plastic and Reconstructive Surgery Unit, University of Pisa, Santa Chiara Hospital, Pisa, Italy; Scuola Superiore Sant'Anna di Studi Universitari e Perfezionamento, Pisa, Italy.
Plastic and Reconstructive Surgery Unit, University of Pisa, Santa Chiara Hospital, Pisa, Italy.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1563-1570. doi: 10.1016/j.bjps.2017.06.018. Epub 2017 Jun 27.
The distally based peroneus brevis muscle flap has proved to be a simple solution for small- to moderate-sized wounds of the lower limb. The length of the muscle belly suitable for coverage is a crucial parameter. In this study, we evaluated the capability of 3D MRI of the lower limb to measure it preoperatively.
Between 2008 and 2017, 32 patients with lower limb defects underwent preoperative MRI to measure the peroneus brevis muscle length. All patients underwent reconstruction, and the muscle was measured again intraoperatively during surgical dissection. Surgical measurements were then compared to the MRI ones.
MRI measures of the peroneus brevis muscle belly ranged from 9 to 21 cm (μ = 14.44 ± 3.43 cm), and intraoperative measures ranged from 9 to 20 cm (μ = 14.2 ± 2.3 cm). Thirty of 32 intraoperative measures corresponded to the MRI ones (variation = ± 1 cm, r = 0.92, p = 0.002). One patient showed an intraoperative muscle length 3 cm shorter than the MRI measure, and another patient had intraoperative muscle length 3 cm longer than the MRI one. All flaps survived, and no secondary local flap coverage was required, with no flap-related complication, limited donor site morbidity, and acceptable patient discomfort.
The reverse peroneus brevis muscle flap is a versatile alternative to free flap reconstruction in small- to moderate-sized defects of the lower limb. Preoperative 3D MRI is accurate to evaluate the anatomy of the muscle when performed by an expert radiologist. In our experience, it should become part of preoperative workup before performing a peroneus brevis flap procedure.
远端蒂腓骨短肌肌瓣已被证明是治疗下肢中小面积伤口的一种简单方法。适合覆盖的肌腹长度是一个关键参数。在本研究中，我们评估了下肢三维磁共振成像（MRI）术前测量该长度的能力。
2008年至2017年期间，32例下肢缺损患者术前行MRI测量腓骨短肌长度。所有患者均接受了重建手术，并在手术解剖过程中术中再次测量该肌肉。然后将手术测量结果与MRI测量结果进行比较。
腓骨短肌肌腹的MRI测量长度为9至21厘米（μ = 14.44 ± 3.43厘米），术中测量长度为9至20厘米（μ = 14.2 ± 2.3厘米）。32例术中测量结果中有30例与MRI测量结果相符（差异 = ±1厘米，r = 0.92，p = 0.002）。1例患者术中肌肉长度比MRI测量结果短3厘米，另1例患者术中肌肉长度比MRI测量结果长3厘米。所有肌瓣均存活，无需二次局部肌瓣覆盖，无肌瓣相关并发症，供区发病率有限，患者不适感可接受。
逆行腓骨短肌肌瓣是下肢中小面积缺损游离肌瓣重建的一种通用替代方法。由专业放射科医生进行术前三维MRI可准确评估肌肉解剖结构。根据我们的经验，它应成为腓骨短肌瓣手术术前检查的一部分。
