Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France.
Otolaryngology, Head and Neck Surgery, King Khalid University, Abha, Kingdom of Saudi Arabia.
Surg Radiol Anat. 2022 May;44(5):637-644. doi: 10.1007/s00276-022-02953-4. Epub 2022 May 16.
This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein.
This anatomical study was performed with 16 fresh cadavers after selective arterial injections of inked serum. The numbers of perforators, diameter, location of the perforasome center, perforator course, the distance between perforator origin and tibiofibular division, and the perforasome area were all documented.
Thirty-one lower legs were dissected. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (1-4). The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). The centers of the perforasomes were aligned on an oblique projection from proximal to distal and anterior to posterior. Seventeen perforators (19%) were musculocutaneous, all in the proximal half of the leg, whereas 71 perforators were septocutaneous (81%), including 18 in the proximal half of the leg. Six of the uppermost perforators originated from the fibular artery less than 10 mm from the tibiofibular division. The mean area perforasome was 37.2 cm (7.9-106 cm) and decreased from proximal to distal (p < 0.01).
Distal and proximal fibular flap perforasomes sported different features. Large skin paddles supplied by large and often intramuscular perforators were found in the proximal half of the leg. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. These factors should be considered in the skin paddle choice during the fibular free flap harvest.
本研究评估游离腓骨皮瓣皮穿支和穿血管体的解剖学特征，以确定其临床意义。
本解剖学研究在选择性动脉注入墨血清后对 16 具新鲜尸体进行。记录穿支数量、直径、穿血管体中心位置、穿支走行、穿支起点与胫腓骨分叉的距离以及穿血管体面积。
共解剖 31 条小腿。共发现 88 条皮穿支，平均每条腿 2.8 条（1-4 条）。平均直径为 1.7mm，从近端到远端逐渐减小（p<0.001）。穿血管体的中心呈从近端到远端、从前到后的斜向排列。17 条穿支（19%）为肌皮穿支，均位于小腿近端，71 条穿支为皮穿支（81%），其中 18 条位于小腿近端。最上面的 6 条穿支起源于腓动脉，距离胫腓骨分叉不到 10mm。穿血管体的平均面积为 37.2cm²（7.9-106cm²），从近端到远端逐渐减小（p<0.01）。
腓骨皮瓣近端和远端的穿血管体具有不同的特征。小腿近端可提供由大且常为肌内穿支供应的大皮瓣。远端皮瓣较小，更靠后，且为皮穿支。在游离腓骨皮瓣采集过程中，应考虑这些因素来选择皮瓣。
