Huddleston Hailey P, Kurtzman Joey S, Koehler Steven M
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, N.Y.
Plast Reconstr Surg Glob Open. 2021 Sep 13;9(9):e3790. doi: 10.1097/GOX.0000000000003790. eCollection 2021 Sep.
Vascularized bone grafting is widely used for reconstruction of osseous defects of the forearm. Fibular free flap (FFF) is one option, which relies on harvesting the peroneal artery. This procedure is subject to lower extremity anatomic variants; therefore, some recommend preoperative angiography. However, high quality evidence for this approach and its cost-effectiveness are lacking and instead one can diligently assess the vascular anatomy intraoperatively. Here, we describe a case of a 73-year-old man who was found to have a peronea arteria magna intraoperatively during an FFF for a left radius reconstruction secondary to an infectious nonunion. We describe an approach to performing an FFF using an arteriovenous vascular loop through the fibula employing the two accompanying peroneal venae comitantes. The patient had no complications and was found to have appropriate healing of the upper extremity without lower extremity compromise at 3-month follow-up. This report illustrates an alternative to using an interpositional venous graft for peronea arteria magna found intraoperatively during FFFs.
带血管蒂骨移植广泛应用于前臂骨缺损的重建。游离腓骨瓣（FFF）是一种选择，它依赖于腓动脉的采集。该手术受下肢解剖变异的影响；因此，一些人建议进行术前血管造影。然而，这种方法及其成本效益缺乏高质量证据，相反，可以在术中认真评估血管解剖结构。在此，我们描述了一例73岁男性患者，在因感染性骨不连继发左桡骨重建而进行FFF手术时，术中发现其存在腓骨大动脉。我们描述了一种通过腓骨使用动静脉血管袢并利用两条伴行腓静脉进行FFF手术的方法。患者无并发症，在3个月的随访中发现上肢愈合良好，下肢未受影响。本报告说明了在FFF手术中术中发现腓骨大动脉时，使用间置静脉移植的一种替代方法。
