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Fibula free flap perforasomes: vascular anatomical study and clinical applications

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

Abstract

Purpose

This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein.

Methods

This anatomical study was performed with 16 fresh cadavers after selective arterial injections of inked serum. The numbers of perforators, diameter, location of the perforasome center, perforator course, the distance between perforator origin and tibiofibular division, and the perforasome area were all documented.

Results

Thirty-one lower legs were dissected. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (1–4). The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). The centers of the perforasomes were aligned on an oblique projection from proximal to distal and anterior to posterior. Seventeen perforators (19%) were musculocutaneous, all in the proximal half of the leg, whereas 71 perforators were septocutaneous (81%), including 18 in the proximal half of the leg. Six of the uppermost perforators originated from the fibular artery less than 10 mm from the tibiofibular division. The mean area perforasome was 37.2 cm2 (7.9–106 cm2) and decreased from proximal to distal (p < 0.01).

Conclusion

Distal and proximal fibular flap perforasomes sported different features. Large skin paddles supplied by large and often intramuscular perforators were found in the proximal half of the leg. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. These factors should be considered in the skin paddle choice during the fibular free flap harvest.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science, so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

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Authors and Affiliations

  1. Maxillo-Facial Surgery Department, Toulouse Purpan University Hospital, Place Baylac, 31059, Toulouse, France

    Vinciane Poulet, Alice Prevost, Zoé Cavallier, Frederic Lauwers & Raphaël Lopez

  2. Otolaryngology, Head and Neck Surgery, King Khalid University, Abha, Kingdom of Saudi Arabia

    Sarah Alshehri

  3. Laboratory of Anatomy, Faculty of Medicine, University of medicine Toulouse-Purpan, Toulouse III-Paul Sabatier, 31062, Toulouse, France

    Frederic Lauwers & Raphaël Lopez

Authors
  1. Vinciane Poulet
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  2. Alice Prevost
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  3. Zoé Cavallier
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  4. Sarah Alshehri
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  5. Frederic Lauwers
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  6. Raphaël Lopez
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Contributions

VP and RL contributed to the study conception and design. Material preparation, data collection and analysis were performed by VP. The first draft of the manuscript was written by the first author and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vinciane Poulet.

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Conflict of interest

The authors have no conflicts of interest to declare regarding the materials or methods used in this study or the findings presented in this paper.

Ethical approval

All procedures in this study were performed in accordance with the ethical standards of the institutional research committee, and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Poulet, V., Prevost, A., Cavallier, Z. et al. Fibula free flap perforasomes: vascular anatomical study and clinical applications. Surg Radiol Anat 44, 637–644 (2022). https://doi.org/10.1007/s00276-022-02953-4

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  • DOI: https://doi.org/10.1007/s00276-022-02953-4

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