Anatomical Study And Clinical Application Of Free Fibular Flap

Objective:Anatomical distribution of fibula blood supply system was analyzed to provide anatomical data for clinical manufacture of free fibula flap?Methods:1.Anatomy analysis:Twenty fresh adult lower limb specimens without trauma(10 males,10 females),douched andinjected with the red latex from femoral artery.Fibulae were divided into proximal,middle and distalby the fibular head and the lateral malleolus.Applying the anatomic methods:the skin was dissected and lifted from the deep fascia in the anterior midsection of the lower leg.The perforations near the long axis of the fibula are retained,with emphasis on the perforations of the gastrocnemius muscle and the flounder muscle near the fibula.The anterior and posterior muscles of the calf were fully exposed and dissected along this gap,and the fibular artery and its branches on the fibular periosteum were fully exposed under the protection of percutaneous artery.The distance between the starting point of the fibular trophoblastic artery and the small head of the fibula and the mean diameter of the vessels were measured.2.Clinical application:A case of bone disunion and bone defect after treatment of right tibia fracture with free fibula flap.Surgery:Draw a line between the bilateral fibula and the tip of the lateral malleolus,Mark 6cm on the outer ankle tip and mark the fibula with the lowest position.The Oval flap was designed with 15 cm × 5.5 cm in size,with the perforation at 15 cm below the fibula head as the center and the fibula surface projected as the axis of the flap.Cut the deep skin fascia along the front of the flap.The superficial layer of deep fascia was dissected horizontally to the posterior margin of the flap,and the branches of the fibula were found between the fibula muscle and the flounder muscle.During the operation,the cutaneous branch was seen to pass through the soleus muscle and the long flexor muscle.Cut off the soleus muscle and the long flexor muscle,and cut the branch completely at 0.3 cm next to the branch.The skin flap was separated from the deep,and the perforation branch of the fibular artery was detected.The perforation branch of the fibular artery was clearly present.The length of fibula(10 cm)was determined according to the defect of the right calf,and the proximal fibula truncation point was located near the perforative branch.Cut the main artery,ligate the proximal end,and remove the whole bone flap.Results;1.Twenty fibula length was 31.4-41.0 cm,Average length was 34.8±17.3 cm the peroneal artery was 12.6-3.5 cm,Average distance was 5.9±2.6 cm,away from fibular head,and the branch of arcuate artery was about 6-2,with an average of 3.45 ±1.23 on each side.The branches were concentrated at 1/3 segment of the fibula.We also observed 1-2 nutrient artery from arcuate artery by medullary foramina.2.Follow-up results:The skin flap survived well after operation,no infection and necrosis,6 months after operation,bone healing of tibia and fibula,beginning to carry weight,16 months after operation,normal walking,22 months after operation,after the examination of X-Ray graft diameter increase 2.2mm,complete load,ankle and toe activity,feeling good.Conclusion:1.The blood supply of the fibula is mainly originated from the peroneal artery and the fibular nutrient artery,the arcuate artery and its branches should be protected in the application of fibula flap in the clinical treatment.2.The branches and distribution of free fibular valve blood vessels are relatively constant,and the blood supply is reliable,which is worthy of clinical application.