The congenital popliteal vasculature patterns in fibular free flap reconstruction by means of surgical anatomy in cadavers

Nutcha Yodrabum,Piyawadee Jongpradubgiat,Natthapong Kongkunnavat,Kosin Panyaatisin,Sasiprapa Pisittrakoonporn,Mathee Ongsiriporn

doi:10.1038/s41598-021-99203-1

Abstract

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone. Thus, understanding its vasculature variation is crucial. This study investigates the popliteal artery branching variations in Thai cadavers and compares them with previous studies. One hundred and sixty-two legs from 81 formalin-embalmed cadavers were dissected. The popliteal artery branching patterns were classified. The previous data retrieved from cadaveric and angiographic studies were also collected and compared with the current study. The most common pattern is type I-A (90.7%). For the variants, type III-A was the majority among variants (6.2%). Type IV-A, hypoplastic peroneal artery, was found in one limb. A symmetrical branching pattern was found in 74 cadavers. Compared with cadaveric studies, type III-B and III-C are significantly common in angiographic studies (p = 0.015 and p = 0.009, respectively). Type I-A is most common according to previous studies. Apart from this, the prevalence of type III-A variant was higher than in previous studies. Furthermore, type III-B and III-C are more frequent in angiographic studies which might be from atherosclerosis. Thus, if the pre-operative CTA policy is not mandatory, the patients at risk for atherosclerosis and population with high variants prevalence should undergo pre-operative CTA with cost-effectiveness consideration.

Highlights

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone
According to the type of popliteal artery branching, we found that type I-A, the common pattern, was the most common type in this study (90.7%)
We have noticed that type III-A limbs have a pedal arterial network originating from AT and distal peroneal artery (PR), replacing the absence of posterior tibial artery (PT)

Summary

Introduction

Fibular free flap (FFF) is frequently used for reconstruction requiring vascularized bone. This study investigates the popliteal artery branching variations in Thai cadavers and compares them with previous studies. Type III-B and III-C are significantly common in angiographic studies (p = 0.015 and p = 0.009, respectively). Apart from this, the prevalence of type III-A variant was higher than in previous studies. The fibular free flap (FFF) was introduced in 1975 by Taylor and colleagues[1,2] This flap was frequently used for reconstructions, especially in defects which require vascularized bone[3]. Type III variants, according to Kim et al and Abou-Foul et al studies, they categorized as having hypoplasticaplastic of AT, PT, and type IV, hypoplastic-aplastic PR which precludes harvesting of vascularized F FF3,9,10. Harvesting of FFF together with PR in these vascular variants may result in foot ischemia of the donor’s leg or unusable fibular flap, respectively[11]

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Conclusion