Abou-Foul A K, Fasanmade A, Prabhu S, Borumandi F
Division of Oral & Maxillofacial Surgery, Head and Neck Surgery Supra-Regional Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK.
Department of Oral & Maxillofacial Surgery, St. Richard's Hospital, Western Sussex Hospitals NHS Foundation Trust, Chichester PO19 6SE, UK.
Br J Oral Maxillofac Surg. 2017 Nov;55(9):904-910. doi: 10.1016/j.bjoms.2017.08.363. Epub 2017 Oct 9.
The fibular free flap (FFF) is based on the peroneal artery, which has a consistent anatomy and makes a minimal contribution to the pedal circulation. However, certain anatomical variations in the vasculature of the leg might leave the peroneal artery with a major role in the perfusion of the foot, and to raise a FFF could lead to ischaemic complications. Our aim was to review the implications of anatomical variants on planning and harvest of a FFF. We systematically reviewed all relevant publications, and included 28 cases that described a dominant peroneal artery and FFF. Most of the patients had clinically normal pulses, and the dominant peroneal artery was diagnosed by preoperative vascular mapping. Variants of the peronea arteria magna were the most common. Bilateral anatomical variations were reported in 10 cases. The surgical plan to harvest the fibula was altered in 21 patients with vascular aberrations. In 17 of the 21, the leg with the anatomical variant was not used. The opposite fibula was used in 10 cases. In four of the 21, the FFF was harvested from the leg with a dominant peroneal artery, after the technique of harvest had been modified. The FFF was successfully harvested without any modification in only five cases. Two patients who had not had preoperative vascular mapping developed acute ischaemia of the limb after harvest of the FFF because of an existing peronea arteria magna. Preoperative vascular mapping is a valuable way to assess that perfusion of the foot is adequate, and it provides accurate information about the vascular anatomy, cutaneous perforators, and the fibular blood supply, with minimal or no added cost or risks.
游离腓骨瓣（FFF）以腓动脉为蒂，其解剖结构恒定，对足部循环的贡献极小。然而，腿部血管的某些解剖变异可能使腓动脉在足部灌注中起主要作用，切取FFF可能导致缺血性并发症。我们的目的是回顾解剖变异对FFF切取计划和操作的影响。我们系统回顾了所有相关文献，纳入了28例描述优势腓动脉和FFF的病例。大多数患者临床脉搏正常，优势腓动脉通过术前血管造影诊断。腓总动脉变异最为常见。10例报告了双侧解剖变异。21例血管异常患者的腓骨切取手术计划发生改变。21例中有17例未使用存在解剖变异的一侧下肢。10例使用了对侧腓骨。21例中有4例在改良切取技术后从存在优势腓动脉的一侧下肢切取了FFF。仅5例未作任何改良即成功切取了FFF。2例未进行术前血管造影的患者在切取FFF后因存在腓总动脉而发生肢体急性缺血。术前血管造影是评估足部灌注是否充足的一种有价值的方法，它能提供有关血管解剖、皮穿支和腓骨血供的准确信息，且增加的成本或风险极小或没有。
