Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sci Rep. 2023 Nov 27;13(1):20844. doi: 10.1038/s41598-023-47619-2.
Preservation of syndesmotic ligaments is crucial for preventing adverse sequelae at the donor site following free fibula osteocutaneous flap harvesting. This study sought to determine the relationship between distal tibiofibular ligaments and the fibular segment to identify radiological landmarks that facilitate safe and precise flap. The distances between the distal tibiofibular ligaments (anterior inferior tibiofibular ligament [AITFL], posterior inferior tibiofibular ligament [PITFL]) and the fibular segment, as well as the lower border of the interosseous membrane, were measured on magnetic resonance imaging (MRI) scans of 296 patients without any perceivable ankle abnormalities. The mean distances (± SD) between the distal end of the fibula and the AITFL, PITFL, and lower interosseous membrane border were 3.0 ± 0.4 cm, 2.6 ± 0.4 cm, and 3.9 ± 0.6 cm, respectively. The distance between the talar dome and the PITFL exhibited a range of 0.0-0.5 cm. Our findings support preserving a distal fibular remnant of at least 4 cm to avoid injury to the syndesmotic ligament throughout fibula osteocutaneous flap harvesting. The talar dome could serve as a useful radiological landmark for identifying the upper border of PITFL during preoperative evaluation, and thus facilitating precise and safe flap procurement.
保护下胫腓联合韧带对于预防游离腓骨骨皮瓣采集后供区的不良后果至关重要。本研究旨在确定远侧胫腓联合韧带与腓骨段之间的关系，以确定有助于安全精确皮瓣的影像学标志。在 296 例无明显踝关节异常的患者的磁共振成像（MRI）扫描中，测量了下胫腓联合韧带（前下胫腓韧带 [AITFL]、后下胫腓韧带 [PITFL]）和骨间膜下缘与腓骨段之间的距离。腓骨末端与 AITFL、PITFL 和骨间膜下缘的平均距离（±SD）分别为 3.0±0.4cm、2.6±0.4cm 和 3.9±0.6cm。距骨穹顶与 PITFL 之间的距离范围为 0.0-0.5cm。我们的发现支持保留至少 4cm 的腓骨远端残端，以避免在游离腓骨骨皮瓣采集过程中损伤下胫腓联合韧带。距骨穹顶可以作为术前评估中识别 PITFL 上缘的有用影像学标志，从而有助于精确和安全的皮瓣采集。
