Leg Flap Research Articles

Simple and Safe Soft-Tissue Coverage Technique Using the Bipedicled Flap in the Lower Leg.

Skin and soft-tissue defects in the lower legs present significant challenges for surgeons, especially when tendons, bones, or implants are exposed. In such cases, simple dressings or skin grafts are insufficient, necessitating flap surgery. The bipedicled flap is a simpler and more reliable method with a high success rate compared to other flaps, showing minimal flap failures. This study aimed to examine the advantages and limitations of using a bipedicled flap for soft-tissue reconstruction in the lower legs. This retrospective study reviewed medical records from January 2013 to May 2020, involving 10 bipedicled flaps performed on the lower legs. The study included 5 male and 5 female patients, with an average age of 54.5 years. The defects were due to various causes, including trauma, tumor surgery, postoperative complications such as dehiscence and skin necrosis, and chronic osteomyelitis. The size of the defects ranged from 4 × 3 cm to 16 × 13 cm. The outcomes assessed included flap viability, postoperative complications, and patient satisfaction. Patient satisfaction was assessed on a 15-point scale, evaluating appearance, function, and sensation with up to 5 points each, and categorizing scores as poor (1-3), below average (4-6), average (7-9), good (10-12), and excellent (13-15). All flaps were successfully performed, and there were no cases showing any special complications. Patient satisfaction following the operation was excellent in 3 patients, good in 6 patients, and average in 1 patient, with an overall average score of 11.5 (good) out of 15 among the 10 patients evaluated. The bipedicled flap is a simple and secure method for treating soft-tissue defects in the lower legs. Therefore, this technique can be considered as one of the viable options for treating such defects.

Fasciocutaneous bridge flap to cover defects on the lower leg after compartment syndrome with acomplication-prone course : An "almost" forgotten safe flap procedure

This article reports on acomplicated case of asoft tissue defect with challenging soft tissue coverage on the lower leg. After alower leg fracture and treatment with atibial nail, a29-year-old man developed compartment syndrome due to massive secondary bleeding with alesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with asoft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated adelayed incomplete healing over 8 months. In addition, X‑ray imaging revealed anonunion and aresulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and adifficult local blood flow situation, the choice of reconstruction procedures was limited. Abridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1year.

Fixation Techniques to Maintain Position for a Cross Leg Flap: Technical Tips and Algorithmic Approach.

Fixation Techniques to Maintain Position for a Cross Leg Flap: Technical Tips and Algorithmic Approach.

Resurfacing complex knee and upper third leg defect with reverse vastus lateralis muscle flap in a flap exhausted leg - A case report

Coverage of upper third leg and knee defects are complex and the main supply of pedicled flaps come from the uninjured leg. Hence planning of flaps from leg must be meticulous, because if these fail then reveres flow flaps from thigh or micro vascular surgery will become the only option. Both have their own set of complications and patients who cannot tolerate micro vascular surgery due to their prolonged duration, co morbidities, and severe atherosclerosis of vessels, end up as thigh flaps being the only resort. Thigh flaps come with a set of complications of their own and even these fail, with above knee amputation being the ultimate option, which patient hardly expects as end result with many stages of reconstruction already being done. It’s a nightmare for both surgeon and patient.

Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections.

Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.

Colorado Needle Assisted Cross-Leg Flap

Lower limb injuries are most commonly due to road traffic accidents which cause lower limb defects.The management of lower limb fractures is guided by the Gustilo-Anderson classification of injuries. Simple leg defects are covered by localflap and complex defects by free flap. Complex defects of the lower limbs which were unfit for free flap require management by conventional cross leg flap. Colorado needle allows meticulous dissection of flaps due to the sharp tip and increases the efficiency in raising the flaps.

Analysis of the effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing oropharyngeal cancer

Objective:To analyze the clinical effect of free posterior lateral peroneal artery perforator flap of lower leg in repairing postoperative defect of oropharyngeal carcinoma. Methods:Thirty-six patients with oropharyngeal carcinoma admitted to the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from June 2016 to June 2019 were analyzed and followed up, eighteen patients were treated with free posterior lateral peroneal artery perforator flap of the lower leg to repair the postoperative defects（experimental group）, and eighteen patients were treated with free forearm flap（control group）. The survival rate of the transplanted flap, the wound stageⅠhealing rate and average hospitalization time were compared between the two groups. Kaplan-Meier method was used to calculate the 1-year and 3-year survival rates of patients after operation, and log-rank test was used to compare the difference between the survival curves of the two groups; The recovery of swallowing and palatopharyngeal closure function of patients in the two groups at 3, 6, 12 and 18 months after operation was calculated and statistically analyzed through the water swallow test and the air blowing method. Results:There was one case of skin flap necrosis in both the experimental group and the control group, and the survival rate was 94.4%. The wound stageⅠhealing rate in the surgical area was 94.4% in both groups. The wound healing rates of the donor area in the experimental group and the control group were 100.0% and 94.4% respectively. The average hospitalization time of the experimental group and the control group was 16.9 days and 17.2 days, respectively, with no significant difference （P>0.05）. The overall survival rates of all patients at 1-year and 3-year were 91.2% and 66.5% respectively; The 1-year and 3-year survival rates of the experimental group and the control group were 94.1%, 69.3% and 88.2%, 63.7%, respectively, and there was no significant difference between the two groups （P>0.05）. The 1-year and 3-year survival rates of P16+ and P16 - patients were 100.0%, 80.0% and 85.7%, 64.3%, respectively, and there was no significant difference between the two groups （P>0.05）. There was no significant difference in the evaluation of swallowing and velopharyngeal closure function between the two groups at 3 and 6 months after operation （P>0.05）, but there was a significant difference at 12 and 18 months after operation （P<0.05）. Conclusion:The anatomic position of the perforating vessels of the free posterior lateral peroneal artery perforator flap of the lower leg is constant, and it can be prepared into single leaf, multi leaf, chimeric and other flaps according to the tissue defect space. And the concealed supply area can be directly drawn to suture. At the same time, the skin flap has strong plasticity. Therefore, the skin flap can be used as a common skin flap to repair the defects after the operation of oropharyngeal carcinoma.

Soft tissue reconstruction of foot and ankle defect using various flap cover: single centre experience

Introduction: Soft tissue defect at ankle and foot region are very common following road traffic accident. Reconstruction in this region is challenging to surgeon because of poor vascularity and paucity of available surrounding tissue. Purpose of study is to evaluate various ankle and foot defect, advantage and disadvantages of different methods of management, future prospective of suitable method according to defect.Materials and Methods: Retrospective study of 65 patients with soft tissue defects around foot and ankle region underwent various reconstructive procedures at SMS hospital Jaipur from January 2020 to December 2020. Study enumerates various etiological factors and describes different reconstructive surgical procedures.Results: Age at presentation range from 8 to 63 years and males were more common. Road traffic accident is most common cause for defect at foot and ankle region followed by diabetic foot and orthopedic implant exposure. Most common site of defect in foot and ankle defect were dorsum of foot followed by lateral malleolus region. Free ALT flap cover performed most frequently followed by cross leg flap.Conclusion: Reverse sural flap is reliable option for small ankle and foot defect near ankle. Cross leg flap is also most reliable option for large defect in opposite healthy limb. Reverse saphanous flap also used for small defects on medial side ankle. Larger defect of ankle and foot can be covered by free fasciocutaneous or myocutaneous flaps where microsurgical expertise available.

Surgical Outcome of Distally Based Peroneus Brevis Flap: A Retrospective Study.

Background: This study aimed to evaluate the surgical outcomes of distally based peroneus brevis muscle flap in post-traumatic lower leg defects.Methods: This is a retrospective analysis conducted from February 2017 to May 2019 including six patients who had sustained post-traumatic lower leg critical soft tissue defects and were treated with distally based peroneus brevis muscle flap and primary skin grafting.Results: In five cases, the flap was successful in providing excellent soft tissue cover to the defects addressed. Partial flap loss was seen in one patient. Skin graft partial loss was seen in three of the six patients. There was no significant donor site morbidity.Conclusions: The distally based peroneus brevis muscle flap is a safe, easy, and reliable flap option for coverage of lower leg defects. The muscle flap also thins with time to provide a good aesthetic outcome.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

Soleus muscle flap for reconstruction of lower extremity trauma. Workhorse or glue factory?

Aim: Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage. In the modern era, many surgeons prefer free flaps. This study sought to evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1 trauma center. Methods: This is an Institutional Review Board -approved, retrospective chart review that was undertaken at Los Angeles County + University of Southern California Medical Center from 2007 to 2021. Patient demographics, Gustilo-Anderson fracture classification, flap characteristics, and outcomes were collected and analyzed. Outcomes of interest included failure rates, postoperative complications, and long-term ambulatory status. Results: Of 187 local leg flaps, 68 (36.4%) were soleus flaps, with 84% of soleus flaps performed prior to 2016. The flap loss rate was 0.0%. Eighteen (26.1%) flaps demonstrated &gt; 1 complication, including osteomyelitis/hardware infection (n = 12), flap revision (n = 6), and amputation (n = 2). Long-term follow-up demonstrated 35.3% of patients ambulating independently after an average of 7.5 ± 7.2 months, with the remainder needing a wheelchair or walking assistance device. Conclusion: Although soleus flap loss rate was 0%, the findings demonstrate more infections than expected; this must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement. Additionally, our results reveal that only 16% of soleus flaps were performed after 2015. As surgeons consider the reconstructive ladder for lower extremity trauma, a rotational soleus muscle flap should not be overlooked in the modern era of free flap tissue transfers and might be a more optimal flap choice in certain patients with multiple comorbidities.

Experience of nephrolexia with cutis-subcutis pedicle flap

At the end of 1929, in the 75th issue of the "New Surgical Archive", N. N. Sokolov's work on nephropexy with a cutis-subcutis leg flap appeared. The author, on the basis of his experience, though insignificant, but taking into account long-term results, gives his method a very positive assessment. Urology Department of the 2nd Sov. hospitals, not being satisfied with the results of nephropexy by other methods, decided to try the method of H. N Sokolov.

Veno-accompanying artery fasciocutaneous flaps following wide excision of soft tissue tumors in the lower legs

BackgroundSoft tissue defects following wide excision of malignant soft tissue tumors (STTs) are sometimes too large for primary closure, especially in the lower legs where available soft tissue is limited. This study aimed to determine the clinical outcomes of reconstruction of a defect after wide excision of an STT with a veno-accompanying artery fasciocutaneous (VAF) flap in the lower leg. MethodsThis study comprised 9 patients with malignant STTs who had undergone reconstructive surgeries using VAF flaps after wide excisions, between October 2010 and September 2017. We retrospectively reviewed and collected data involving age, sex, follow-up period, histological diagnosis, surgical procedures, size and location of defects, size and location of the flaps, venous source of the flaps, direction of the pedicles, closing of donor sites, perioperative chemotherapies, postoperative complications, and the presence of postoperative local recurrence and metastasis. ResultsThe median follow-up period was 91.5 (range, 15.5–189.0) months. Four patients had defects located around the knee, 3 patients had defects located on the calf, and 2 patients had defects located around the ankle. The mean flap size was 95.6 × 119.4 (range, 50 × 100–130 × 140) mm. Six patients had venous sources from the small saphenous vein and 3 patients had venous sources from the great saphenous vein. The pedicles were proximally based in 4 patients and distally based in 5 patients. All flaps remained viable without any complications. ConclusionsOur findings showed that the VAF flap was easily elevated and reliable. Furthermore, it was effective in reconstructing soft tissue defects following wide excisions of STTs in the lower leg.

Reverse flow cross leg sural flap as a reconstructive option for traumatic defects in the lower leg circumventing free flaps

Very few flaps described in the literature would be as versatile as the reverse sural flap. In spite of its few shortcomings, it is one of the most widely used flaps for lower third defects in the leg because of the paucity of tissues in the region. In a lot of situations, free tissue transfer is the only feasible option because of non-availability of local options in the involved limb. In such a scenario, a reverse sural flap from the contralateral leg can be manoeuvred in a cross leg fashion as an alternative to free flap. It employs skin and soft tissue from the opposite limb which can easily cover large defects in the lateral malleolar and tendoachilles region which would be unachievable with a traditional cross leg flap. A prospective study was developed from September 2018 to March 2020 at SMS Hospital, Jaipur. A total of 10 patients underwent flap cover. Rigid fixation with the help of external fixator was used to prevent flap avulsion, and flaps were divided at 3 weeks. All cases were done in 2 stages, fixed with external fixator and divided at 3 weeks. All 10 flaps survived without any flap failure. One flap had ischaemic changes in the distal most part of the flap which was later debrided and flap advanced to cover the defect. Successful coverage of defect was achieved in all 10 patients, and donor site healed uneventfully. In our experience, a reverse flow cross leg sural flap is a significant option for leg defects where there is a paucity of nearby tissues for stable flap cover and as an alternative to free flap. It is an excellent option for covering large defects over the lateral side of the leg where a traditional cross leg flap cannot reach. It can also circumvent the use of free flaps in patients who cannot undergo a long duration surgery. The relative simplicity of this flap makes it a very useful flap for large defects of the lower third of leg. Level of evidence: Level IV, therapeutic study.

Peroneal flap: How to harvest and clinical appraisal for head and neck reconstruction

A peroneal flap, the boneless version of fibula flap, is considered as the equivalent of radial forearm flap of the lower leg. Because it is thinner than an anterolateral thigh (ALT) flap, the use of a peroneal flap is a viable option for the repair of soft tissue defects when a thin flap could bring about better functional and cosmetic outcomes. In this article, we describe the details of peroneal flap harvest and present our experience with the use of peroneal flaps for head and neck reconstruction. Between 1996 and 2017, a total of 265 peroneal flaps were used to reconstruct a variety of head and neck defects. With the same vascular anatomy and slight modifications to the harvesting technique of a fibula flap, a peroneal flap can be harvested within 1-2 h. All medical records were retrospectively reviewed. A peroneal flap can be harvested as different types of chimeric flaps to fit a variety of head and neck defects. The peroneal flap failure rate was 3.4% and the postoperative complication rate was 12.8%. A peroneal flap might be an alternative option for the reconstruction of head and neck defects.

Delayed Arteriovenous Fistula after Reverse Flow Sural Island Flap in Lower Leg: A Case Report

Delayed arteriovenous (AV) fistula after soft tissue reconstruction with flap surgery is a rare complication. Here, we describe a case of delayed AV fistula formation after 4 years of reverse flow sural island flap surgery in the lower leg. The patient had swelling, tenderness, and color change to dark purple on previous flap area and foot, similar to cellulitis. Thrill and murmur were observed. AV fistula was formed around the previous vascular pedicle area, as revealed in angiography. We excised the right posterior tibial artery-saphenous vein fistula. The patient is having satisfactory progress since the surgery. We suggest that AV fistula was caused by enhanced angiogenesis and vascular damage.

Reliability and Versatility of Reverse Sural Island Neurofasciocutaneous Leg Flaps.

Distally based sural neurofasciocutaneous (NFC) flaps are a commonly used method for foot and ankle reconstruction given that they are much simpler and, at the same time, still efficient alternative to perforator flaps and free style free flaps. This study aims to evaluate the reliability and versatility of reverse sural island NFC flaps as a powerful and efficient method that can be used for repair of lower leg skin defects. This method does not require microsurgical facilities or extensive training. Patients with soft tissue defects of the distal third of the leg and ankle region received reverse sural island NFC flaps. Inclusion criteria included an absence of damage to the sural neurovascular axis or communicating perforators, absence of peripheral vascular disease, and the presence of soft tissue defects deep enough to expose tendon or bone. Patients were assessed for flap (defect) size, pedicle length and location of defects, postoperative flap survival rates, and complications. Donor sites were closed directly or skin grafted. Of 24 consecutive patient (20 male; 4 female), all flaps except 1 (4.16%), survived, although partial necrosis was observed in 2 patients (8.33%). The overall major complication rate was 12.50%. Epidermolysis was noted in 1 patient (4.16%). Three cases of transient venous congestion resolved without additional complications. The overall minor complication rate was 16.66%. Minimal complications were associated with healing of donor sites. Reverse sural island NFC flaps provide adequate and aesthetically very acceptable coverage of soft tissue defects of the distal lower leg and proximal foot with no functional impairment.

Reversed Hemisoleus Flap for Traumatic Wound Coverage in the Distal Third of the Leg

AbstractBackground: Reconstruction of soft tissue defects of the distal third leg are common challenging therapeutic problems with significant long-term morbidity. Treatment options include cross leg flaps, local flaps (as muscle flaps and fasciocutaneous flaps) and the free vascularized flaps.Aim of Study: The aim of this study is to evaluate the clinical outcome of reversed hemisoleus muscle flap in cov-erage of traumatic soft tissue defects in the distal third of the leg.Patients and Methods: In this prospective study, we present 21 patients with traumatic soft tissue defects in the distal third leg with exposure of bone, tendons and neurovas-cular structures, managed by reversed medial hemisoleus muscle flap. Clinical and radiological data were analyzed.Results: The outcome of the flap surgery was evaluated after at least 6 months follow-up on the basis of flap survival, graft intake, functional gain and donor site morbidity [1]. Clinical results were graded as excellent, good, fair as follows: 13 showed excellent results (61.9%), 7 showed good survival (33.3%) and 1 flap was graded as fair (4.8%) with no poor results. The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Accordingly, satisfactory results were found in 20 patients (95.2%), and the unsatisfactory results were found in 1 patient (4.8%) with reliable soft-tissue cov-erage and complete wound healing in all patients.Conclusion: This study shows that reversed medial hem-isoleus muscle flap is a reliable reconstructive option for traumatic soft tissue defects on the medial side of the distal tibia in selected cases.

Clinical effect of free anterolateral thigh flap in repairing large annular soft tissue defect of lower leg after burn

Objective: To explore the clinical effect of free anterolateral thigh flap in repairing large annular soft tissue defect of lower leg after burn. Methods: From January 2014 to December 2018, 9 patients with large annular soft tissue defects of lower legs after burns were hospitalized in Zhengzhou First People's Hospital, including 1 case with wounds on both legs. After debridement, area of wounds was 16 cm×11 cm-38 cm×21 cm, and the burn wounds were repaired with free anterolateral thigh flaps in the area of 18 cm×12 cm-32 cm×24 cm. End-to-end anastomosis of posterior tibial vessels or anterior tibial vessels with lateral circumflex femoral vessels was performed in manual way or by microvascular stapler. For the affected legs without condition for anastomosis, the sound medial lower leg flaps with areas of 10 cm×8 cm-15 cm×10 cm were excised and made into skin tubes, the posterior tibial vessels of the flaps were anastomosed with the vessels of free anterolateral femoral flaps, and the wounds of the injured lower legs were repaired by bridge-type cross-over free transplantation of anterolateral thigh flaps. The pedicles were broken 4 to 5 weeks later. The donor site was transplanted with autologous intermediate split-thickness skin graft from thigh. The outcome of the treatment, the number of perforators included in the flaps, and the anastomotic vessel in the recipient area of patients were recorded. The anastomosis time between manual way and microvascular staplers was recorded and compared. The patency of blood vessels, methods of free transplantation, and follow-up condition were recorded. Data were processed with Wilcoxon rank sum test for two independent samples. Results: All the 10 free flaps and skin grafts of 9 patients survived, and all the wounds were closed by primary operation. Seven flaps contained two perforators each, and three flaps contained three perforators each. The anastomotic vessels were posterior tibial vessels in 6 recipient areas and anterior tibial vessels in 4 recipient areas. Microvascular stapler was used to anastomose 12 veins, while 8 veins and 10 arteries were anstomosed manually. The time consumed by the former method was 4.00 (3.55, 4.38) min, significantly shorter than 12.80 (12.13, 13.40) min of the latter (W=78.00, P<0.01). The patency rates of veins and arteries were 100%. There was no vascular crisis due to vascular anastomosis. Three patients underwent bridge-type cross-over free transplantation, while the others underwent conventional free transplantation. Follow-up for 3 to 30 months showed that the donor site of the thigh had good motor function, without numbness or pain, but hypertrophy of scar could be seen. Four patients had slightly overstaffed flaps transplanted in the recipient area of the lower legs, while the other patients were satisfied with their appearance, and the walking function of the affected limbs gradually recovered. Conclusions: Free anterolateral thigh flap transplantation is a safe and reliable clinical limb salvage method for the repair of large annular soft tissue defect of lower leg after burn. Intraoperative application of microvascular stapler for venous anastomosis can shorten the time of vascular anastomosis and has great clinical application value.

Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer.

Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated. In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4-2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3-3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9-31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9-31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18-58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48-105 cm3). Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.