Abstract
Introduction
Transfer of proximal epiphysis and diaphysis of fibula is a treatment of bony defects in children. Although there are few reports of this procedure, different arteries or combination of arteries have been used as supplying pedicle and the reported success rates are different. This is an anatomical study to clarify the vascular anatomy of this region.
Materials and methods
A total of 16 fresh cadavers were enrolled. An incision was made in the popliteal fossa to find the popliteal artery, which was dissected distally and the lateral inferior genicular artery, anterior tibial artery, tibioperoneal trunk and its bifurcation were located. In eight subjects popliteal artery was cannulated above the level of femoral condyles and injected by latex. In the next eight cases the same material was injected in the anterior tibial artery. The next steps of dissection were done by 4.3-loupe magnification. Lateral inferior genicular artery was dissected from its origin to the fibular head and branches of anterior tibial artery were also dissected. In three specimens, the fibula and its supplying arteries were removed after dissection and put in diluted hydrochloric acid to be opened for studying the medullary vasculature.
Results
This study confirms the existence of not only periosteal but also intramedullary anastomosis between artery of the neck and peroneal artery. Artery of the neck was usually a branch of anterior tibial artery and in 24% of the subjects a branch of popliteal artery. In the latter condition the pedicle would be too short to permit the surgeon to do this surgery. Therefore preoperative angiography is mandatory to identify the origin of the artery of the neck.
Conclusion
According to these dissections, a classification system of arterial supply of proximal fibular epiphysis is introduced in this article.
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References
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 7:1504–1511
Taylor GI, Wilson KR, Rees MD, Corlett RJ, Cole WG (1998) 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
Tsai TM, Ludwig L, Tonkin M (1986) Vascularized fibular epiphyseal transfer. A clinical study. Clin Orthop Relat Res 210:228–234
Enneking WF, Mindell ER (1991) Observations on massive retrieved human allograft. J Bone Joint Surg Am 73:1123–1142
Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction des os longs par membrane induite et autogreffe spongieuse. Ann Chir Plast Esthet 45:346–353
Concannion MJ, Croll GH, Boschert MT, Gaines RW, Puckett CL (1993) Free fibular transfer in a growing individual (Long term results). Microsurgery 14:624–627
Ferracini R, Gino G (1999) Assessment of vascularized fibular graft one year after reconstruction of the wrist after excision of a giant cell tumor. J Hand Surg 24B:497–500
Innocenti M, Delcroix L, Manfrini M, Ceruso M, Capanna R (2005) Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg Am 87:237–246
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
Menzes-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
Wood MB, Gilbert A (1997) Microvascular bone reconstruction. Martin Dunitz, UK, pp 75–79
Restrepo J, Katz D, Gilbert A (1980) Arterial vascularization of proximal epiphysis and the diaphysis of the fibula. Int J Microsurg 2:49–54
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
Capanna R, Innocenti M, Ceruso M, Caldora P, Campanacci DA, Beltrami G, Gluckert B (1997) La greffe vascularisee du perone en croissance dans la chirurgie de tumeurs de l’os chez l’enfants. Maitrise Orthop 64:22–23
Innocenti M, Delcroix L, Romano GF, Capanna R (2007) Vascularized epiphyseal transplant. Orthop Clin North Am 38:95–101
Sawaizumi M, Maruyama Y, Okajima K, Motegi M (1991) Free vascularized epiphyseal transfer designed on the reverse anterior tibial artery. Br J Plast Surg 44:57–59
Acknowledgments
The authors are thankful to Dr Restrepo J for his invaluable help in providing the casting model of intramedullary anastomosis between AON and PA.
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Mozaffarian, K., Lascombes, P. & Dautel, G. Vascular basis of free transfer of proximal epiphysis and diaphysis of fibula: an anatomical study. Arch Orthop Trauma Surg 129, 183–187 (2009). https://doi.org/10.1007/s00402-008-0600-3
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DOI: https://doi.org/10.1007/s00402-008-0600-3