J reconstr Microsurg 2019; 35(06): 438-444
DOI: 10.1055/s-0039-1677769
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer

Ulrike Maria Hamscha
1  Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, Vienna, Austria
,
Wolfgang Josef Weninger
1  Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, Vienna, Austria
,
Christian Freystätter
1  Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, Vienna, Austria
,
Chieh-Han Tzou
2  Department of Surgery, Plastic and Reconstructive Surgery, Hospital of the Divine Savior, Vienna, Austria
,
Christine Radtke
3  Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

09 July 2018

09 December 2018

Publication Date:
31 January 2019 (eFirst)

Abstract

Background Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg.

Methods Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated.

Results In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4–2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3–3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18–58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48–105 cm3).

Conclusion Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.