Jones N F, Monstrey S, Gambier B A
Division of Plastic and Reconstructive Surgery at the University of Pittsburgh, PA, USA.
Plast Reconstr Surg. 1996 Apr;97(4):707-16; discussion 717-8. doi: 10.1097/00006534-199604000-00003.
There is ongoing controversy regarding the reliability of the skin island associated with the fibular osteocutaneous flap for mandibular reconstruction. Anatomical dissections and a clinical series of mandibular reconstructions using the fibular osteocutaneous flap have demonstrated unequivocally that a skin flap can be reliably harvested with the fibula based purely on the septal perforators, without needing to incorporate portions of the soleus or flexor hallucis longus muscles or to perform any intramuscular dissection or anastomosis of the muscle perforators. However, the skin island should be designed more distally over the distal third of the lower leg at the junction of the middle and distal thirds of the fibula. A fibular osteocutaneous flap was designed over the distal third of the fibula in 60 fresh cadavers, and each flap was completely isolated on the septum and all muscle perforators were ligated before dye injection. A major perforator through the soleus muscle or flexor hallucis muscle was identified in 41 of 60 dissections (67 percent) and discrete septal perforators were identified under loupe magnification in 45 dissections (75 percent). All 60 flaps demonstrated 100 percent reliable perfusion of the skin island after injection of the proximal peroneal artery with methylene blue or red latex. This anatomical study was corroborated with 100 percent survival of 34 fibular osteocutaneous flaps for mandibular reconstruction with the skin island designed over the distal third of the lower leg and based only on septal perforators without incorporating the soleus or flexor hallucis muscles. Reliability of this fibular osteocutaneous flap for mandibular reconstruction is attributed to (1) design of the skin island more distally over the distal third of the lower leg, (2) preoperative precision Doppler mapping of the perforators, and (3) design of the closing wedge osteotomies of the fibula to protect the septocutaneous perforators transversing through the posterior periosteum of the fibula.
关于用于下颌骨重建的腓骨骨皮瓣所带皮岛的可靠性，目前仍存在争议。解剖研究以及一系列使用腓骨骨皮瓣进行下颌骨重建的临床病例明确显示，仅基于间隔穿支血管，无需包含比目鱼肌或拇长屈肌的部分肌肉，也无需进行任何肌肉内解剖或肌肉穿支血管吻合，就能够可靠地获取与腓骨相连的皮瓣。然而，皮岛应设计在小腿远端三分之一处，位于腓骨中、下三分之一交界处的更远处。在60具新鲜尸体上，于腓骨远端三分之一处设计腓骨骨皮瓣，每个皮瓣在间隔上完全分离，所有肌肉穿支血管在染料注射前均予以结扎。在60次解剖中有41次（67%）发现有一支主要穿支血管穿过比目鱼肌或拇长屈肌，在45次解剖（75%）中在放大镜下发现了离散的间隔穿支血管。在用亚甲蓝或红色乳胶注射腓骨近端动脉后，所有60个皮瓣的皮岛灌注均显示100%可靠。这项解剖学研究得到了34例用于下颌骨重建的腓骨骨皮瓣100%存活的证实，这些皮瓣的皮岛设计在小腿远端三分之一处，仅基于间隔穿支血管，未包含比目鱼肌或拇长屈肌。这种用于下颌骨重建的腓骨骨皮瓣的可靠性归因于：（1）皮岛设计在小腿远端三分之一处的更远处；（2）术前对穿支血管进行精确的多普勒定位；（3）腓骨闭合楔形截骨术的设计，以保护穿过腓骨后骨膜的间隔皮穿支血管。
