| Object: To investigate the effect the reparation of the crus skin soft tissue defects and bone defects using the osteocutaneous flaps of healthy side fibula long section vascular bridging anastomosis. At the present time, fibula osteocutaneous flaps are one of the most effective methods of reparation of complex tissue defect of crus. But encountering vascular injury of crus at the same time and the absence of blood vessel to anastomose in the recipient area, the operation will be difficult. There were the greater distress and the longer course of treatment to the patients with other methods. It was higher risk to operation directly as there was only one main blood vessel and the local inflammatory edema and the necrosis of the limb was possible. For the sake of shortened the course and decreased the rate of disability, the effective method for the compound defect of leg accompanied with the absence of blood vessel to be anastomosed in the recipient area was applied after anatomical study and clinical application.Material and methods: There were two parts of the experiment, and the first was the anatomic study. The thirty sides fresh lower limbs specimens of human being perfused with red emulsoid via the artery were used. The conformations of femoral artery in adductor canal were observed, the distance each branches to adductor canal exitus were measured and the diameter and the path of branches were observed. The anatomies of the osteocutaneous flaps of fibula were also observed, including the blood supply of fibula, the distance from each branches to the fibula head, the path and the diameter of beginning. The second part of the experiment was the clinical application. 8 case of crus skin soft tissue defects and bone defects were repaired with the osteocutaneous flaps of fibula with long section vascular bridging anastomosis, 4 case with both of anterior tibial and fibular artery injured and 4 case with anterior tibial artery injured. The fibular arteries of the osteocutaneous flaps were anastomosed with femoral artery end-to-side or with branches of it, such as genus descendsus artery, end-to-end. The fibular veins were anastomosed with the great saphenous vein end-to-end orvascular grafted.Result: (1) After anatomic studying, the primary branches of the femoral arterywere genus descendsus artery in the adductor canal. The distances to adductortendinous opening were 6.7±0.6cm,and the diameter of arterial origins were 2.0±0.08mm. Fibular artery was branched from posterior tibial artery at average6.6cm point below fibula head, and the diameter of arterial origin was 3.8(1.4-5.6) mm. The accompanying vein was joined in posterior tibial vein at average 5.1cm point below fibula head, and the diameter of it was 4.6(1.2-6.8) mm. The fibular artery was directed laterally and inferiorly, away from fibula at beginning, close to it downwards. The distances from the nutrient artery of fibula to fibula head were 14.2(10.3-23.4) cm and the distances to the origin of fibular artery were 6.8(2.1-18.2) cm. The distances between the first arching artery and fibula head were 9.2cm, and the diameter of arterial origin was 1.4mm. The skin arteries of flaps were made of branches of arching artery and musculocutaneous artery. The distances of course through deep fascia were about 4cm. (2) Result of clinical application: Scase of the grafted osteocutaneous flap of fibula were survived. The donor areas were healed by first intention.lease experienced thrombosis of vein 12 hour later postoperation. After exploration and anastomosis once again, the flap was survived. 2case with light infection were healed after treated in time. 5case were survived with ruddy and good elasticity of flaps. Function exercises were practised 3weeks later plaster fixation. Walking on crutches was permitted 1 month later. Follow-up period ranged from 6month to 28month. Bony unions were obtained between tibia and grafted fibula after 6month and both of them were widened. External fixator and Kirschner pin were removed 6-9month later p...
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