Department of Plastic, Reconstructive and Aesthetic Surgery, Kocaeli University Faculty of Medicine, Kocaeli-Türkiye.
Department of Orthopedics and Traumatology, Kocaeli University Faculty of Medicine, Kocaeli-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Nov;28(11):1645-1649. doi: 10.14744/tjtes.2021.26794.
Osteoseptocutaneous fibula flap is commonly used as the workhorse flap for bone reconstruction. However, the use of previously fractured fibula as a free or pedicled flap for bone reconstruction has a limited knowledge in the literature. There is not any data in the literature about a case with proximal level of fibula fracture which was used as an anterograde pedicled osteocutaneous fibula flap for composite tibial reconstruction after high-energy injury. Based on a patient in whom the composite defect of the proximal tibial region was reconstructed with osteocutaneous fibula flap after a gunshot injury, it was tried to show that the fibula with a proximal level fracture could be used with anterograde flow in the subacute period and it is thought that the usability of this flap should be kept in mind. It is possible to harvest the pedicled fibula flap even in the subacute period with the evaluation of CT angiography preoperatively and with the checking the patency and flow direction of peroneal artery perioperatively. The success of the procedure may be increased through total dissection of inflammatory areas of pedicle which would extend into the injury zone during the subacute period.
带蒂腓骨皮瓣是一种常用的骨重建工作皮瓣。然而，将先前骨折的腓骨作为游离或带蒂皮瓣用于骨重建的应用在文献中知之甚少。目前尚无文献报道腓骨近端骨折病例，该病例在高能损伤后被用作顺行带蒂骨皮瓣进行胫骨复合重建。基于 1 例因枪伤导致胫骨近端区域复合缺损患者，采用带蒂腓骨皮瓣进行重建，我们尝试证明在亚急性期，带有近端骨折的腓骨可以采用顺行血流，并认为应该记住这种皮瓣的可用性。通过术前 CT 血管造影评估和术中检查腓动脉的通畅性和血流方向，可以在亚急性期采集带蒂腓骨皮瓣。在亚急性期，通过对进入损伤区的蒂部炎症区域进行完全解剖，可以增加手术的成功率。
