The anatomical investigation for harvesting various chimeric flaps based on the peroneal artery
Keywords:Peroneal artery, Fibula, Chimeric flap, Perforator, Periosteum
Background: The conventional fibular composite flap with its various components tethered together is not maneuverable enough to cover the complex three dimensional defects. An in-depth anatomical study into the peroneal vascular system was performed to explore the possibility of harvesting various the fibular chimeric composite.
Methods: 30 cadaveric lower extremities with perfusion of red latex in their arteries were used for this study. The fibular head and the lateral malleolus were used as the landmarks and the calf was divided into the upper, middle and lower segments, respectively. Dissection of the calves was carried out to investigate mainly the muscuo (septo) cutaneous perforators and periosteal branches given off from the peroneal artery.
Results: An average of 4.8±0.9 cutaneous perforators was given off from the peroneal artery to nourish the lateral aspect of the lower leg. An average number of 4.7±1.3 periosteal branches were given off from the peroneal artery to the surface of the fibula. In 40% of the cases, a periosteal branch to the tibia with an external diameter of about 0.8 mm was found to originate from the peroneal artery. In 60% of cases, 2 to 3 periosteal branches with an external diameter of about 0.6 mm were found to originate from the peroneal artery. Several patterns of the chimeric fibular composite flap can be harvested based on the peroneal artery.
Conclusions: It is anatomically practical to harvest various patterns of chimeric fibular composite flaps based on the peroneal artery to reconstruct three-dimensional complex defects.
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55(5):533-44.
Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br. 2010;92(11):1568-73.
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71-9.
Tonkin MA, Hanel DP, Scheker LR. Vascularized fibular osteocutaneous graft: surgical technique and clinical study. Aust N Z J Surg. 1990;60(1):51-7.
Jones NF, Monstrey S, Gambier BA. Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation. Plast Reconstr Surg. 1996;97(4):707-16.
Wei FC, El-Gammal TA, Lin CH, Ueng WN. Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects. J Trauma. 1997;43(5):784-92.
Arai K, Toh S, Tsubo K, Nishikawa S, Narita S, Miura H. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg. 2002;109(7):2301-6.
Huang WC, Chen HC, Wei FC, Cheng MH, Schnur DP. Chimeric flap in clinical use. Clin Plast Surg. 2003;30(3):457-67.
Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg. 1991;27(2):126-31.
Wang CY, Chai YM, Wen G, Han P. One-stage reconstruction of composite extremity defects with a sural neurocutaneous flap and a vascularized fibular graft: a novel chimeric flap based on the peroneal artery. Plast Reconstr Surg. 2013;132(3):428e-37e.
Massarelli O, Gobbi R, Biglio A, Soma D, Tullio A. Chimeric lateral supramalleolar artery perforator fibula free flap in the reconstruction of composite head and neck defects. Plast Reconstr Surg. 2014;133(1):130-6.
Infante-Cossio P, Sicilia-Castro D, Garcia-Perla A, Gutierrez-Perez JL, Gomez-Cia T. Chimeric lateral supramalleolar artery perforator fibula free flap in the reconstruction of composite head and neck defects. Plast Reconstr Surg. 2014;134(2):329e-31e.
Masquelet AC, Beveridge J, Romana C, Gerber C. The lateral supramalleolar flap. Plast Reconstr Surg. 1988;81(1):74-81.
Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg. 2013;71(5):503-9.
Soldado F, Fontecha GC, Haddad S, Hernandez-Fernandez A, Corona P, Guerra-Farfan E. Treatment of congenital pseudarthrosis of the tibia with vascularized fibular periosteal transplant. Microsurgery. 2012;32(5):397-400.
Soldado F, Fontecha CG, Barber I, Velez R, Llusa M, Collado D, Rodriguez-Baeza A, Martinez-Ibanez V. Vascularized fibular periosteal graft: a new technique to enhance bone union in children. J Pediatr Orthop. 2012;32(3):308-13.
Finley JM, Acland RD, Wood MB. Revascularized periosteal grafts--a new method to produce functional new bone without bone grafting. Plast Reconstr Surg. 1978;61(1):1-6.
Trignano E, Fallico N, Faenza M, Rubino C, Chen HC. Free fibular flap with periosteal excess for mandibular reconstruction. Microsurgery. 2013.
Jie Q, Yang L, Zhu QS, Zhao L, Li MQ. Biomechanical effect of major extremity vessels in choosing repair methods for peripheral artery injury. Chin J Traumatol. 2007;10(3):154-8.
Trumble TE, McCallister WV. Repair of peripheral nerve defects in the upper extremity. Hand Clin. 2000;16(1):37-52.
Colen KL, Choi M, Chiu DT. Nerve grafts and conduits. Plast Reconstr Surg. 2009;124(6):e386-94.
Terzis JK, Kostopoulos VK. Vascularized nerve grafts and vascularized fascia for upper extremity nerve reconstruction. Hand. 2010;5(1):19-30.
Terzis JK, Kostopoulos VK. Vascularized nerve grafts for lower extremity nerve reconstruction. Ann Plast Surg. 2010;64(2):169-76.
Millesi H. Techniques for nerve grafting. Hand Clin. 2000;16(1):73-91,viii.