Osteocutaneous proximal fibular flap: an anatomical and computed tomographic angiographic study of skin and bone perfora
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ANATOMIC BASES OF MEDICAL, RADIOLOGICAL AND SURGICAL TECHNIQUES
Osteocutaneous proximal fibular flap: an anatomical and computed tomographic angiographic study of skin and bone perforators Kanit Sananpanich1 · Artit Boonyalapa1 · Jirachart Kraisarin1 · Nuttaya Pattamapaspong2 Received: 1 February 2020 / Accepted: 1 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Introduction Vascularized proximal fibular epiphyseal transfer is a reconstruction method for joints and growing bones. The authors investigated the vascular supply of the proximal fibula, including skin perforators, for suitability in creating an osteocutaneous flap. Methods Twenty fresh cadaveric knees were studied using computed tomographic angiography combined with anatomical dissection. Three-dimensional angiography was used to develop an overview, and multiplanar two-dimension angiography was used for detailed data collection. Anatomical dissection verified by angiography was used to locate skin perforators of the proximal part of the anterior tibial artery. Results Proximal fibular bone perforators from the anterior tibial artery were found to arise either from the anterior tibial recurrent artery, the posterior tibial recurrent artery or the circumflex fibular artery in every specimen (100%), whereas perforators from the inferolateral genicular artery met those criteria in 12 of 18 specimens (66.7%). In the proximal half of 20 anterior tibial arteries, 129 skin perforators with a diameter larger than 0.5 mm were found. There were 54 potential septocutaneous skin perforators between the extensor digitorum longus and the peroneus longus muscles (EDL/PL), and 18 between the extensor digitorum longus and the tibialis anterior muscles (TA/EDL). Skin perforators from the inferolateral genicular artery emerging from the posterolateral corner of the knee had a diameter of < 0.5 mm. Conclusion Based on this cadaveric study, the reverse flow anterior tibial artery pedicle and the EDL/PL or TA/EDL skin perforators can be considered as options for osteocutaneous proximal fibular transfers. Keywords Fibular flap · Epiphyseal transfer · Chimeric flap · Osteocutaneous flap
Introduction Vascularized fibular epiphyseal transfer has increasingly been used for reconstruction in children at several sites which must accommodate future bone growth and which involve an articular surface, e.g., the distal radius [6, 7, 21, 26], distal ulna [28], proximal humerus [6, 13], ankle [2, 3], and proximal femur [20]. In addition, the proximal fibula has also been used to reconstruct bony defects and restore joint surfaces in skeletally mature patients [4, 19, 25]. Pedicle type is one of the important factors related to bone growth * Nuttaya Pattamapaspong [email protected] 1
Department of Orthopedics, Chiang Mai University, Chiang Mai, Thailand
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
2
rate after a vascularized proximal fibular epiphyseal transfer. Inconsistent results aft
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