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Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction

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Abstract

Purpose

Initially described by Baudet in 1982, the fibula flap including the lateral head of the soleus muscle allows a one-stage reconstruction for large maxillo-mandibular defects. The aim of this study was to evaluate the number of muscular branches destined to the soleus muscle and their distance from the origin of the fibular artery, to assess the vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction.

Methods

We performed a cadaveric anatomic study on ten lower limbs, and a CT angiography anatomic study on 38 legs. The number of soleus branches originating from the fibular artery, and the distance between the origin of the fibular artery and each of the identified branches were measured.

Results

The number of soleus branches destined to the lateral head of the soleus muscle is variable, with in our study 1–3 branches found. Soleus branches destined to the lateral head of the soleus muscle emerged at a distance ranging between 0 and 2.9 cm (mean value = 1.82 cm) from the origin of the fibular artery in 40% of cases, between 3 and 5.9 cm (mean value = 4.27 cm) from the origin of the fibular artery in 37% of cases, and was at a distance of 6 cm or more (mean value = 6.93 cm) from the origin of the fibular artery in 20% of cases.

Conclusions

An origin of the soleus vessels in close proximity to the origin of the fibular artery represents the main limitation of this flap, the length of the remaining fibular pedicle making it difficult to achieve secure anastomosis in the cervical area. The vascular distribution of the proximal part of the lateral head of the soleus muscle being segmental, it is possible to lengthen the flap pedicle ligating the most proximal soleus branches originating from the fibular artery.

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Author information

Authors and Affiliations

  1. Anatomy Laboratory of the University of Medicine Paris V René Descartes, AP-HP Surgical School, Paris, France

    Lara Nokovitch

  2. Department of Maxillo-Facial Surgery, University Hospital of Amiens, Picardie Jules Verne University, Amiens, France

    Lara Nokovitch, Julien Davrou, Bernard Devauchelle & Stéphanie Dakpé

  3. Department of Maxillo-Facial Surgery, Beaujon Hospital, AP-HP, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Christian Vacher

  4. Radiology Department, Gustave Roussy Institute, Villejuif, France

    François Bidault

  5. University of Medicine Paris-Diderot, EA 2496, Paris, France

    Christian Vacher

Authors
  1. Lara Nokovitch
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  2. Julien Davrou
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  3. François Bidault
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  4. Bernard Devauchelle
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  5. Stéphanie Dakpé
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  6. Christian Vacher
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Contributions

LN: protocol development, data collection, data analysis, manuscript writing. JD: data analysis, manuscript writing. FB: data collection. BD: other. SD: other. CV: protocol development, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Christian Vacher.

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Nokovitch, L., Davrou, J., Bidault, F. et al. Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction. Surg Radiol Anat 41, 447–454 (2019). https://doi.org/10.1007/s00276-018-2166-2

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  • DOI: https://doi.org/10.1007/s00276-018-2166-2

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