Skip to main content

Advertisement

SpringerLink
Log in

Osteocutaneous proximal fibular flap: an anatomical and computed tomographic angiographic study of skin and bone perforators

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Introduction

Vascularized proximal fibular epiphyseal transfer is a reconstruction method for joints and growing bones. The authors investigated the vascular supply of the proximal fibula, including skin perforators, for suitability in creating an osteocutaneous flap.

Methods

Twenty fresh cadaveric knees were studied using computed tomographic angiography combined with anatomical dissection. Three-dimensional angiography was used to develop an overview, and multiplanar two-dimension angiography was used for detailed data collection. Anatomical dissection verified by angiography was used to locate skin perforators of the proximal part of the anterior tibial artery.

Results

Proximal fibular bone perforators from the anterior tibial artery were found to arise either from the anterior tibial recurrent artery, the posterior tibial recurrent artery or the circumflex fibular artery in every specimen (100%), whereas perforators from the inferolateral genicular artery met those criteria in 12 of 18 specimens (66.7%). In the proximal half of 20 anterior tibial arteries, 129 skin perforators with a diameter larger than 0.5 mm were found. There were 54 potential septocutaneous skin perforators between the extensor digitorum longus and the peroneus longus muscles (EDL/PL), and 18 between the extensor digitorum longus and the tibialis anterior muscles (TA/EDL). Skin perforators from the inferolateral genicular artery emerging from the posterolateral corner of the knee had a diameter of < 0.5 mm.

Conclusion

Based on this cadaveric study, the reverse flow anterior tibial artery pedicle and the EDL/PL or TA/EDL skin perforators can be considered as options for osteocutaneous proximal fibular transfers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Aldekhayel S, Govshievich A, Neel OF, Luc M (2016) Vascularized proximal fibula epiphyseal transfer for distal radius reconstruction in children: a systematic review. Microsurgery 36:705–711. https://doi.org/10.1002/micr.22521

    Article  PubMed  Google Scholar 

  2. Bibbo C, Ehrlich DA, Kovach SJ 3rd (2015) Reconstruction of the pediatric lateral malleolus and physis by free microvascular transfer of the proximal fibular physis. J Foot Ankle Surg 54:994–1000. https://doi.org/10.1053/j.jfas.2014.12.004

    Article  PubMed  Google Scholar 

  3. Cavadas PC, Thione A (2015) Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap: a case report. J Pediatr Orthop B 24:370–372. https://doi.org/10.1097/BPB.0000000000000176

    Article  PubMed  Google Scholar 

  4. Chung DW, Han CS, Lee JH, Lee SG (2013) Outcomes of wrist arthroplasty using a free vascularized fibular head graft for Enneking stage II giant cell tumors of the distal radius. Microsurgery 33:112–118. https://doi.org/10.1002/micr.22028

    Article  PubMed  Google Scholar 

  5. Imre N, Battal B, Acikel CH, Akgun V, Comert A, Yazar F (2012) The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography. Surg Radiol Anat 34:427–432. https://doi.org/10.1007/s00276-011-0930-7

    Article  PubMed  Google Scholar 

  6. Innocenti M, Ceruso M, Manfrini M, Angeloni R, Lauri G, Capanna R, Bufalini C (1998) Free vascularized growth-plate transfer after bone tumor resection in children. J Reconstr Microsurg 14:137–143. https://doi.org/10.1055/s-2007-1000157

    Article  CAS  PubMed  Google Scholar 

  7. Innocenti M, Delcroix L, Manfrini M, Ceruso M, Capanna R (2004) Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg Am 86-A:1504–1511

    Article  Google Scholar 

  8. Innocenti M, Delcroix L, Romano GF (2005) Epiphyseal transplant: harvesting technique of the proximal fibula based on the anterior tibial artery. Microsurgery 25:284–292. https://doi.org/10.1002/micr.20130

    Article  PubMed  Google Scholar 

  9. Innocenti M, Delcroix L, Romano GF, Capanna R (2007) Vascularized epiphyseal transplant. Orthop Clin North Am 38(95–101):vii. https://doi.org/10.1016/j.ocl.2006.10.003

    Article  Google Scholar 

  10. Iorio ML, Cheerharan M, Olding M (2012) A systematic review and pooled analysis of peroneal artery perforators for fibula osteocutaneous and perforator flaps. Plast Reconstr Surg 130:600–607. https://doi.org/10.1097/PRS.0b013e31825dbff3

    Article  CAS  PubMed  Google Scholar 

  11. Kim JS, Son DG, Choi TH, Kim NG, Lee KS, Han KH, Kim JH, Lee SI, Kang D (2008) An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps. Ann Plast Surg 60:710–716. https://doi.org/10.1097/SAP.0b013e3180cab77f

    Article  CAS  PubMed  Google Scholar 

  12. Kim NG, Lee KS, Choi TH, Kim JS, Choi JH, Jang PY, Han KH, Son DG, Kim JH (2008) Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap. J Plast Reconstr Aesthet Surg 61:934–938. https://doi.org/10.1016/j.bjps.2007.06.006

    Article  PubMed  Google Scholar 

  13. Menezes-Leite MC, Dautel G, Duteille F, Lascombes P (2000) Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application. Surg Radiol Anat 22:235–238

    Article  CAS  Google Scholar 

  14. Morsy M, Sur YJ, Akdag O, Sabbagh MD, Suchyta MA, El-Gammal TA, Lachman N, Moran SL (2019) Vascularity of the proximal fibula and its implications in vascularized epiphyseal transfer: an anatomical and high-resolution computed tomographic angiography study. Plast Reconstr Surg 143:172e–183e. https://doi.org/10.1097/PRS.0000000000005127

    Article  CAS  PubMed  Google Scholar 

  15. Mozaffarian K, Lascombes P, Dautel G (2009) Vascular basis of free transfer of proximal epiphysis and diaphysis of fibula: an anatomical study. Arch Orthop Trauma Surg 129:183–187. https://doi.org/10.1007/s00402-008-0600-3

    Article  PubMed  Google Scholar 

  16. Papadopulos NA, Weigand C, Kovacs L, Biemer E (2009) The free vascularized fibular epiphyseal transfer: long-term results of wrist reconstruction in young patients. J Reconstr Microsurg 25:3–13. https://doi.org/10.1055/s-0028-1090614

    Article  PubMed  Google Scholar 

  17. Ribuffo D, Atzeni M, Saba L, Guerra M, Mallarini G, Proto EB, Grinsell D, Ashton MW, Rozen WM (2010) Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Surg Radiol Anat 32:329–334. https://doi.org/10.1007/s00276-009-0559-y

    Article  PubMed  Google Scholar 

  18. Sananpanich K, Atthakomol P, Luevitoonvechkij S, Kraisarin J (2013) Anatomical variations of the saphenous and descending genicular artery perforators: cadaveric study and clinical implications for vascular flaps. Plast Reconstr Surg 131:363e–372e. https://doi.org/10.1097/PRS.0b013e31827c7067

    Article  CAS  PubMed  Google Scholar 

  19. Scaglioni MF, Chang EI, Gur E, Barnea Y, Meller I, Kollander Y, Bickels J, Dadia S, Zaretski A (2014) The role of the fibula head flap for joint reconstruction after osteoarticular resections. J Plast Reconstr Aesthet Surg 67:617–623. https://doi.org/10.1016/j.bjps.2014.01.014

    Article  CAS  PubMed  Google Scholar 

  20. Soldado F, Fontecha CG, Haddad S, Corona P, Collado D, Llusa M, Rego P (2012) Composite vascularized fibular epiphyseo-osteo-periosteal transfer for hip reconstruction after proximal femoral tumoral resection in a 4-year-old child. Microsurgery 32:489–492. https://doi.org/10.1002/micr.21988

    Article  PubMed  Google Scholar 

  21. Taylor GI, Wilson KR, Rees MD, Corlett RJ, Cole WG (1988) The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications. Br J Plast Surg 41:451–469

    Article  CAS  Google Scholar 

  22. The Federative International Programme for Anatomical Terminology (2019) Terminologia Anatomica. 2nd edn. Available via https://fipat.library.dal.ca/wp-content/uploads/2020/05/FIPAT-TA2-Part-4.pdf. Accessed 6 Jun 2020

  23. Tsai TM, Ludwig L, Tonkin M (1986) Vascularized fibular epiphyseal transfer. A clinical study. Clin Orthop Relat Res 228–234

  24. Wei FC, Chen HC, Chuang CC, Noordhoff MS (1986) Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 78:191–200

    Article  CAS  Google Scholar 

  25. Wu SP, Zhang FH, Yu FB, Zhou R (2009) Medial malleolus and deltoid ligament reconstruction in open ankle fractures with combination of vascularized fibular head osteo-tendinous flap and free flap transfers. Microsurgery 29:630–635. https://doi.org/10.1002/micr.20689

    Article  PubMed  Google Scholar 

  26. Yang J, Qin B, Li P, Fu G, Xiang J, Gu L (2015) Vascularized proximal fibular epiphyseal transfer for Bayne and Klug type III radial longitudinal deficiency in children. Plast Reconstr Surg 135:157e–166e. https://doi.org/10.1097/PRS.0000000000000836

    Article  CAS  PubMed  Google Scholar 

  27. Yang X, Zhang G, Liu Y, Yang J, Ding M, Tang M (2013) Vascular anatomy and clinical application of anterolateral leg perforator flaps. Plast Reconstr Surg 131:534e–543e. https://doi.org/10.1097/PRS.0b013e3182827675

    Article  CAS  PubMed  Google Scholar 

  28. Yang YF, Zhang GM, Huo ZQ, Xu ZH, Xu DC (2013) Reconstruction of the distal ulnar epiphysis with vascularized proximal fibula including epiphysis in children after osteochondroma resection: report of two cases. Plast Reconstr Surg 132:784e–789e. https://doi.org/10.1097/PRS.0b013e3182a3bf98

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We express our deepest gratitude to the individuals who donated their bodies and to their families. We would also like to gratefully acknowledge Dr. G. Lamar Robert, who reviewed the English language and Mrs. Areerak Phanphaisan, who conducted the statistical analysis of the data.

Funding

The research was supported by Faculty of Medicine, Chiang Mai University (Grant number 055/2557).

Author information

Authors and Affiliations

  1. Department of Orthopedics, Chiang Mai University, Chiang Mai, Thailand

    Kanit Sananpanich, Artit Boonyalapa & Jirachart Kraisarin

  2. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand

    Nuttaya Pattamapaspong

Authors
  1. Kanit Sananpanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Artit Boonyalapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jirachart Kraisarin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuttaya Pattamapaspong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KS was involved in project and protocol development, cadaver dissection, manuscript writing. AB was involved in protocol development and cadaver dissection. JK was involved in project development and cadaver dissection. NP was involved in protocol development, radiographic interpretation and manuscript editing.

Corresponding author

Correspondence to Nuttaya Pattamapaspong.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sananpanich, K., Boonyalapa, A., Kraisarin, J. et al. Osteocutaneous proximal fibular flap: an anatomical and computed tomographic angiographic study of skin and bone perforators. Surg Radiol Anat 43, 1099–1106 (2021). https://doi.org/10.1007/s00276-020-02591-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-020-02591-8

Keywords

Search

Navigation