The anatomical investigation for harvesting various chimeric flaps based on the peroneal artery

Abstract

Background: The conventional fibular composite flap with its various components tethered together is not maneuverable enough to cover the complex three dimensional defects. An in-depth anatomical study into the peroneal vascular system was performed to explore the possibility of harvesting various the fibular chimeric composite. Methods: 30 cadaveric lower extremities with perfusion of red latex in their arteries were used for this study. The fibular head and the lateral malleolus were used as the landmarks and the calf was divided into the upper, middle and lower segments, respectively. Dissection of the calves was carried out to investigate mainly the muscuo (septo) cutaneous perforators and periosteal branches given off from the peroneal artery. Results: An average of 4.8±0.9 cutaneous perforators was given off from the peroneal artery to nourish the lateral aspect of the lower leg. An average number of 4.7±1.3 periosteal branches were given off from the peroneal artery to the surface of the fibula. In 40% of the cases, a periosteal branch to the tibia with an external diameter of about 0.8 mm was found to originate from the peroneal artery. In 60% of cases, 2 to 3 periosteal branches with an external diameter of about 0.6 mm were found to originate from the peroneal artery. Several patterns of the chimeric fibular composite flap can be harvested based on the peroneal artery. Conclusions: It is anatomically practical to harvest various patterns of chimeric fibular composite flaps based on the peroneal artery to reconstruct three-dimensional complex defects.