With Vascular Pedicle Of The Fibular Graft For Repair Of Tibial Fractures,

Objective: To study the results of the vascularized fibula grafts repairing of tibial complexity fracture.Methods: 1. On the men and women a total of 10 bodies of the lower extremity were observed around the fibula on an important branch of the vessel and its adjacent relations for clinical transplantation fibula ,at the same time provided anatomical basis for the operation that should pay attention to the problem. 2. Select 24 clinical cases, all of the open and tibiaâ…¢fracture, 10 cases were with multiple injuries, 4 cases were with anterior tibial merger (or) with the posterior tibial vascular injury, 5 cases were with the merger tibial nerve injury, 5 cases were with the merger of common peroneal nerve injury. 16 cases were treated primarily with fibular or compositus tissue flap transplantation with vascule anastomosis;injurded nerves,blood vessels and soft tissues were restoude .8 cases accepted delayded trdatment.They were followed up for more than one year. Then give plan to regulate clinics.Results: 1. Peroneal artery start in the fibular head below the average 6.8 cm pointed at the posterior tibial artery, the initial diameter of 3.6 (1.6 to 5.8) mm; 8 bodies have two concomitant vein ,2 bodies have only one concomitant vein.The veins fall into the posterior tibial vein from the average distance fibula head 5.2 cm,diameter of 4.7 (2.4 ~ 6.9) mm. 2 On superior segment of the fibular;one branch from the popliteal artery moving towards the capitulum branched out three arteries.one of them run downwards(diameter 1.6 mm) and turned to nourish artery of the fibular periosteum.The second branch hooked the fibula horizontally and run backwards.The third(1.5 mm)went upwards ,then entered the knee joint directly. In the middle of segment, tiny nutrient arteries of fibula entered the fibula regularly besides the main nutuent artery(diameter of 2.1 mm)of fibula.Generally,there is an artery to fibular periosteum(diameter of 1.9 mm) came from the fibular artery. In the lower segment, there are 2-3 arcuate arteries originated from the fibula artery(diameter 0.8 mm)to supply the muscles located lateral to the fibula.Protection of the those arteries will contribute great dealto the reduction of complications occurrence.3 The average diameter of the posterior tibial artery is 3.3 (1.5 ~ 4.0) mm, the average diameter of the anterior tibial artery is 2.8 (1.6 ~ 4.0) mm, the great saphenous vein average diameter is greater than 3.0 mm, small saphenous vein is average diameter of about 2.76 mm. Vessel can be end-to-end anastomosis. 4. Postoperative follow-up of 12 months, 24 patients with fractures of the bone have been heal.The blood vessels and nerves which had been repaired has entered the next phase of the rehabilitation period. None of the patients suffered infection.Conclusion:The way that repair the tibia fracture,comminuted by vascularized fibula grafts can promote healing and reduce disability, infection and amputation rate. Treatment of this disorder is effective way.