Including fascia as in the case of a fasciocutaneous flap increases survey of the flap. The fibular artery arises approximately 2.5cm after the posterior tibial artery arises, distal to the popliteal muscle, where it descends along the medial aspect of the fibula. official website and that any information you provide is encrypted Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Fibula free flap: a new method of mandible reconstruction. 2007 Jan;38(1):13-22, v. doi: 10.1016/j.ocl.2006.10.012. Therefore, these donors and their families deserve our highest gratitude. Plast Reconstr Surg 2008;122:16170. Sananpanich K, Boonyalapa A, Kraisarin J, Pattamapaspong N. Surg Radiol Anat. https://doi.org/10.1016/j.main.2015.09.003, Book The chimeric peroneal artery perforator flap was designed in the middle and upper leg . (B) The. PMC 2023 Springer Nature Switzerland AG. Federal government websites often end in .gov or .mil. The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study. Keyword Highlighting An enlarged/hypertrophied perforating fibular artery is observed emanating from the interosseus membrane and serves as the replaced dorsalis pedis artery in the dorsum of the foot. importance of the fibular artery as the dominant of the 3 infrapopliteal branching arteries, reinforcing or replacing the posterior tibial artery (PTA) when it is weak or absent by a strong communicating branch or, reinforcing a weak ATA and dorsalis pedis artery (D PA) by a strong perforating fibular artery as being reported. An official website of the United States government. doi: 10.1097/MD.0000000000023590. Plast Reconstr Surg 2012;130:6007. Your message has been successfully sent to your colleague. Upon reaching the ankle joint, it terminates at the anterior surface of the tibia midway between the medial and lateral malleoli, and is continued by the dorsalis pedis artery. https://doi.org/10.1097/PRS.0b013e31825dbff3, Article FOIA These factors should be considered in the skin paddle choice during the fibular free flap harvest. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Materials and methods: The nutrient artery of the femur is usually given off from the second perforating artery; when two nutrient arteries exist, they usually spring from the first and third perforating vessels. Out of all of them, one branch is usually of a larger caliber. Since then, the anatomical characteristics and identification strategies for cutaneous branches of the peroneal artery have been extensively studied. [1] Subsequently, the osteocutaneous fibular flap was first reported in 1983 by Chen and Yan,[2] who harvested the skin paddle based on perforators taken off from peroneal vessels to the skin. The first perforating branch of the deep femoral artery is an appropriate alternative recipient vessel for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head. Fibular artery; Fibular free flap; Perforasome; Perforator; Reconstruction. Federal government websites often end in .gov or .mil. Detailed anatomic studies and live surgery of the infrapopliteal vasculature have led to increased reliability of diversity in the cutaneous skin island.[4,5]. Plast Reconstr Surg Glob Open 5:1543. https://doi.org/10.1097/GOX.0000000000001543, Article Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Published by Elsevier Ltd. All rights reserved. Distal and proximal fibular flap perforasomes sported different features. Perforators of the fibular artery and suprafascial network. https://doi.org/10.1002/micr.20684, Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. However, the main disadvantage of scapular free-flap raising is the fact that the 2-team approach is sometimes not possible, and intraoperative position changes are time-consuming. You can freely give, refuse or withdraw your consent at any time by accessing our cookie settings tool. (A) The graft bone had incorporated well with the residual mandible, and the mandible contour was restored well. The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). Perforating vessels from the peroneal . The https:// ensures that you are connecting to the Federal government websites often end in .gov or .mil. The crural fascia is very thick, so . Microsurgery 1983;4:116. Please enable scripts and reload this page. -, Plast Reconstr Surg. official website and that any information you provide is encrypted Unauthorized use of these marks is strictly prohibited. The .gov means its official. Human anatomy 2 Human body Parts of human body Regions of human body Musculoskeletal systems Visceral systems Integrating systems Endocrine glands Cardiovascular system Blood Lymph Vessels Vascular plexuses Heart Pulmonary vessels Cardiac vessels Systemic arteries Aorta Common carotid artery Cerebral arterial circle Arteries of spinal cord Plast Reconstr Surg 1986;78:191200. Proximal peroneal perforator in dual-. J Reconstr Microsurg 8:215223, Article All data generated or analyzed during this study are included in this published article [and its supplementary information files]. Surg Radiol Anat. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. The fibular artery (also known as peroneal artery) is one of the three arteries of the leg, along with the anterior and posterior tibial arteries. Ann Plast Surg. Perforating fibular artery 5. Plast Reconstr Surg 111:20032008. Introduction. Because of anatomic variations or surgical injuries of the perforating vessels, many skin paddles cannot be successfully harvested. Epub 2022 May 16. Bergmans comprehensive encyclopedia of human anatomic variation. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 128:440446. This article will discuss the anatomy and function of the anterior tibial artery. and grab your free ultimate anatomy study guide! Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Potter JK, Lee MR, Oxford L, et al. The site is secure. Epub 2018 Sep 18. Google Scholar, Leclre FM, Bosc R, Temam S, Leymarie N, Mirghani H, Sarfati B et al (2014) Reconstruction of large mandibulofacial defects with the composed double skin paddle fibula free flap: a review of 32 procedures. Accessibility The site is secure. Along their course, the anterior tibial arteries give off posterior and anterior recurrent tibial, muscular, perforating, and anterior medial and lateral malleolar arteries. The first perforating artery arises from the deep artery of the thigh above the adductor brevis, the second in front of this muscle, and the third immediately below it. No perforator was located at more than 2 cm from fibular posterior border. 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. In this regard, the concept of predesigning the proximal perforator as a substitute will be significant, since skin paddle loss or unavailability may occasionally occur due to distal perforator loss or absence. The patient has provided informed consent for publication of the case. Deep fibular nerve 4. Would you like email updates of new search results? Soft tissue defect on lower limb can result in an intractable wound. [12,13] In some conditions, when the defect is extensive, this skin paddle also fails to offer enough soft-tissue volume. There was no recurrence of the tumor during the 2-year follow-up assessment. Unauthorized use of these marks is strictly prohibited. 4A and B), and the composite defects were . Bethesda, MD 20894, Web Policies Please try again soon. CAS We found that fibular perforators clustered in the middle and upper third of the leg. Kenhub. Plast Reconstr Surg. The peroneal artery then courses towards the fibular bone and descends down the lower leg along the posterior surface of the interosseus membrane between the fibula and tibia. The authors sincerely thank those who donated their bodies to science, so that anatomical research could be performed. Simultaneously, the skin paddle was designed according to the perforators of the peroneal artery guided by Doppler ultrasonography, and an anterior approach was made via an incision along the anterior edge of the flap and dissected under a subfascial plane. https://doi.org/10.1016/j.anplas.2015.09.002, https://doi.org/10.1007/s00276-017-1927-7, https://doi.org/10.1016/j.joms.2015.02.004. J Surg Oncol 116:258262. government site. [2] Conclusion: https://doi.org/10.1097/01.PRS.0000056833.17907.01, Taylor GI, Corlett RJ, Dhar SC, Ashton MW (2011) The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (14). The operation lasted for 7 hours, with an estimated blood loss of 300 mL. Foy JP, Qassemyar Q, Assouly N, Temam S, Kolb F (2016) Harvesting technique of chimeric multiple paddles fibular flap for wide oromandibular defects. In summary, our preliminary experience showed that the proximal perforator skin paddle fibular free flap is reliable and practical for the reconstruction of composite oromandibular defects. It has a very consistent anatomy with a suitable location and diameter for anastomosis of the peroneal artery. Along its course in the posterior compartment of the leg, the anterior tibial artery is found between the heads of the tibialis posterior muscle. This suprafascial vascular axis could be an anatomical basis for a fasciocutaneous fibular flap. Anatomy of abdomen and lower limb. Tibial-fibular trunk Picture of arteries of the lower limb, showing fibular artery and its source, the posterior tibial artery . . Int Orthop. Additionally, perforating vessels from the peroneal artery can support a skin paddle . During its short course through the posterior compartment of the leg, the anterior tibial artery runs anteriorly between the heads of the tibialis posterior muscle. 2018 Aug;40(8):927-933. doi: 10.1007/s00276-017-1927-7. Hanley and Belfus, Philadelphia, pp419426, Heitmann C, Khan FN, Levin LS (2003) Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. Tetik C, Baar H, Bezer M, Erol B, Air I, Esemenli T. Acta Orthop Traumatol Turc. The anterior tibial artery gives off several branches during its course; the posterior and anterior recurrent tibial, muscular, perforating, and anterior medial and lateral malleolar branches. The first perforating artery (a. perforans prima) passes posteriorly between the pectineus and adductor brevis (sometimes it perforates the latter); it then pierces the adductor magnus close to the linea aspera. The mean diameters of the ascending branch of the lateral circumflex femoral and the peroneal arteries were 2.0 and 3.6 mm, respectively. Google Scholar, Ozalp T, Masquelet AC, Begue TC (2006) Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap. -, Br J Plast Surg. The .gov means its official. Jones NF, Monstrey S, Gambier BA. This study proves the real existence of a microvascular suprafascial axis formed by fibular perforator anastomoses and stretching over the entire length of the fibula, from the fibular head to the distal tip of the lateral malleolus. The mean area perforasome was 37.2cm2 (7.9106cm2) and decreased from proximal to distal (p<0.01). What is compartmental syndrome? They pass backward near the linea aspera of the femur underneath the small tendinous arches of the adductor magnus muscle. These factors should be considered in the skin paddle choice during the fibular free flap harvest. https://doi.org/10.1016/j.joms.2013.12.011, Ribuffo D, Atzeni M, Saba L, Guerra M, Mallarini G, Proto EB et al (2010) Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Dissection allowed us to raise in all specimens a large fasciocutaneous paddle including a fine arteriolar vessel connecting fibular perforators. Sinnatamby, C. S., & Last, R. J. Yu et al stated that the distal group of perforators, usually 1 to 3 in number, was generally located over the lower third quarter of the fibula, and was critical to the skin paddle design. J Reconstr Microsurg 19:157162. Purpose Previous studies of cutaneous perforators of the peroneal artery have shown great variability, and attest to the significant anatomical variability in this region. Together with the anterior and posterior tibial arteries, the peroneal artery represents 1 of the 3 main branches of the popliteal artery. Unable to load your collection due to an error, Unable to load your delegates due to an error. Julien Gaillard. (stands for: nterior tibial recurrent, osterior tibial recurrent, ircumflex fibular, utaneous, alleolar) Dorsalis pedis artery -, J Reconstr Microsurg. Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series. http://creativecommons.org/licenses/by/4.0. The anterior tibial artery may take on a different course, running along the lateral side of the leg, only to regain its anterior position at the level of the ankle joint. The numbers of perforators, diameter, location of the perforasome center, perforator course, the . Proximal perforators were closer to posterior fibular side than distal perforators. 2001 Jul;54(5):428-33 PubMed 2016 Jun;76(6):705-12. doi: 10.1097/SAP.0000000000000258. Application of Posterior Thigh Three-Dimensional Profunda Artery Perforator Perforasomes in Refining Next-Generation Flap Designs: Transverse, Vertical, and S-Shaped Profunda Artery Perforator Flaps. Surgical and Radiologic Anatomy CAS Plast Reconstr Surg. London: Elsevier Health Sciences APAC. VP and RL contributed to the study conception and design. The second perforating artery (a. perforans secunda), larger than the first, pierces the tendons of the adductores brevis and magnus, and divides into ascending and descending branches, which supply the posterior femoral muscles, anastomosing with the first and third perforating. the branch of the peroneal artery that perforates the interosseous membrane just above the anterior tibiofibular ligament. Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, perforating arteries (of deep femoral artery), perforating branch of anterior interosseous artery, perforating branches of internal thoracic artery, perforating branches of plantar metatarsal arteries, perforating arteries (of internal thoracic artery), perforating arteries of deep femoral artery, perforating arteries of internal thoracic artery, perforating branches (of palmar metacarpal arteries), perforating branches of palmar metacarpal arteries, Perforating Injuries with Retinal Detachment. The perforators derived from the peroneal artery supply perfusion to the cutaneous portion of the flap, and in combination with the fibular graft, allow favorable reconstruction of composite soft- and hard-tissue defects. https://doi.org/10.1002/lary.24452, Lin YS, Liu WC, Wang KY, Lin YS, Yang KC (2019) Obliquely-arranged double skin paddles: a novel design to reconstruct extensive head and neck defects with a single fibula or peroneal flap. Fibular (peroneal) artery - descends posteriorly to the fibula, within the posterior compartment of the leg. Although the perforating branches of the deep femoral artery have been introduced as recipient vessels for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head, comprehensive knowledge of the related anatomy is deficient. Written informed consent was obtained from the patient preoperatively after he was given a detailed explanation of the operative procedures and backup planning. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. https://doi.org/10.1007/s00276-022-02953-4, access via (A) Preoperative view of the intraoral mucosa of the patient with ameloblastoma; the surface of the oral mucosa was ruptured. The arteriography showed the features as follows. 2020 Dec 11;99(50):e23590. Bookshelf Please try after some time. Perforators of the fibular artery and suprafascial network. Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am. perforating branch of fibular artery the branch of the peroneal artery that perforates the interosseous membrane just above the anterior tibiofibular ligament. To benefit from all the features, its recommended to keep the different cookie categories activated. Reviewer: Copyright Anatomy; Fasciocutaneous flap; Fibular artery; Skin perforators; Suprafascial network. Careers. Elsevier Masson, Issy-les-Moulineaux, pp 1819. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Li J, Song P, Yang D, Hu K, Chen M, Xu C, Sun Y. Nan Fang Yi Ke Da Xue Xue Bao. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. Even though 2-team work can be performed by placing the patients in a tilted decubital position,[15] flap raising is still cumbersome because of the proximity between the 2 operation teams. Rising a perforator flap avoids to sacrifice a major vessel whence the nourishing perforator artery is born. Inbal A, Gur E, Zaretski A, Barnea Y, Khafif A, Amir A (2015) The Origami composite free fibula flap for complex defects of the mandible, floor of the mouth, and tongue. Introduction. J Reconstr Microsurg 19:157162, Iorio ML, Cheerharan M, Olding M (2012) A systematic review and pooled analysis of peroneal artery perforators for fibula osteocutaneous and perforator flaps. Data curation: Kang Liu, Yue Wang, Dan-Wei Xiang and Hai-Bo Shi. Mimics Medical 20.0 (Materialise, Leuven, Belgium) was used to convert CTA Digital Imaging and Communications in Medicine data into 3D objects. All authors read and approved the final manuscript. Surg Radiol Anat 32:329334. When you visit IMAIOS, cookies are stored on your browser. In the present case, we raised a skin paddle based on the proximal peroneal artery, which successfully rescued the distal perforator absence and avoided exploration for a second donor site, thereby saving time and precluding the need for another set of recipient vessels. The https:// ensures that you are connecting to the The diameters of the perforating branches were compared with those of the ascending branch of the lateral circumflex femoral and the peroneal arteries. Results: HHS Vulnerability Disclosure, Help Chang EI, Yu P (2017) Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap. PMC Google Scholar, Taylor GI, Pan WR (1998) Angiosomes of the leg: anatomic study and clinical implications. 4A and B), and the composite defects were successfully reconstructed (Fig. Conclusion This study proves the real existence of a microvascular suprafascial axis formed by fibular perforator anastomoses and stretching over the entire length of the fibula, from the fibular head to the distal tip of the lateral malleolus. These branches supply the structures of the Key facts about the anterior tibial artery Posterior and anterior recurrent tibial, muscular, perforating, and anterior medial and lateral malleolar arteries Proximal tibiofibular joint, knee joint, ankle joint, muscles and skin of the anterior compartment of the leg Masson, Paris, Schaverien M, Saint-Cyr M (2008) Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. As a general rule, the deep veins accompany and share the name of the major arteries in the lower limb. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Jun 30;40(6):814-821. doi: 10.12122/j.issn.1673-4254.2020.06.07. Branch of the anastomosis of the lateral tarsal and the perforating fibular arteries Enters the sinus tarsi from the lateral end to supply the neck of the talus. Different Recipient Vessels for Free Microsurgical Fibula Flaps in the Treatment of Avascular Necrosis of the Femoral Head: A Systematic Review and Meta-analysis. However, in cases with large soft-tissue defects, to prevent extremely tight closure of the soft tissue that will lead to dehiscence and infection, the contralateral shank will have to be explored or another cutaneous flap will have to be selected to restore the soft tissue defect, which can increase morbidity of second donor-site and can also be time-consuming. We found that ultrasonic mapping had erroneously located the perforators, and we also confirmed the congenital absence of the distal perforators. Purpose: Surgeons resort in flaps to cover these injuries. MeSH The deep venous drainage system of the lower limb is located beneath the deep fascia of the lower limb. I would honestly say that Kenhub cut my study time in half. Medicine (Baltimore). The artery terminates at the level of the ankle joint, where it gives off its terminal branch, the dorsalis pedis artery. https://doi.org/10.1007/s00276-017-1927-7, Heitmann C, Khan FN, Levin LS (2003) Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. You can consent to the use of these technologies by clicking "accept all cookies". 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. https://doi.org/10.1097/PRS.0b013e31821e705. Part of Springer Nature. Upon its entry in the anterior compartment, the anterior tibial artery runs medially alongside the deep fibular (peroneal) nerve. 2022 Jan 15;36(1):79-85. doi: 10.7507/1002-1892.202106117. Keywords: Lateral tarsal artery & lateral branch of deep fibular nerve 6. A sufficient bone length of the fibula can offer an approximately 26-cm bone graft in an adult, whereas the bone stock of the scapula may sometimes be insufficient. A 62-year-old man was referred to us due to a 6-month history of mandibular swelling and soft tissue involvement. The osteocutaneous fibula flap: an anatomic study. The peroneal artery (also termed the fibular artery) is the posterior lateral branch of the tibial-peroneal trunk in the lower extremity just distal to the popliteal fossa. Br J Plast Surg 34:215220, Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 89:11151121, Miyamoto S, Kayano S, Nagamatsu S, Sakuraba M (2012) Perforator anatomy of the fibula osteocutaneous flap. doi: 10.1097/PRS.0000000000003224. The lateral tarsal artery forms anastomoses (connections) with the perforating branch of the fibular artery and several others near the ankle joint. Please enable it to take advantage of the complete set of features! Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Posterior and anterior recurrent tibial, muscular, perforating, and anterior medial and lateral malleolar arteries, Proximal tibiofibular joint, knee joint, ankle joint, muscles and skin of the anterior compartment of the leg. Project administration: Wei Zhang and Qi-Lin Liu. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature. The skin paddle was then redesigned and the perforator was dissected retrogradely through the soleus to the source vessels similar to the process while raising a perforator skin flap. No perforator was located at more than 2cm from fibular posterior border. Epub 2017 Sep 21. The skin paddle was then redesigned and the perforator was dissected retrogradely through the soleus to the source vessels similar to the process while raising a perforator skin flap. This study was approved by the ethics institutional review board of the hospital of stomatology, Jilin University. Mohan AT, Zhu L, Sur YJ, Morsy M, Michalak GJ, Lachman N, Rammos CK, Saint-Cyr M. Plast Reconstr Surg. . This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. The first perforating branch was always located medial to the tendinous insertion of the gluteus maximus, whereas the second perforating branch was always located distal to the gluteus maximus. Jana Vaskovi MD J Oral Maxillofac Surg 72:11971202. Preoperative imaging has been suggested as a means for improving preoperative awareness, with . The mean area perforasome was 37.2 cm2 (7.9-106 cm2) and decreased from proximal to distal (p < 0.01). 2021 Oct;43(10):1697-1702. doi: 10.1007/s00276-021-02800-y. official website and that any information you provide is encrypted National Library of Medicine - 173.212.249.81. government site. PubMedGoogle Scholar. Conclusion: Intraoral examination revealed lingual and labial expansion of the left mandibular alveolar process along with a partially abnormal mucosa. In a prospective study, Yu et al observed 2 distinct groups of perforators along the long axis of the fibula bone based on their distribution and named these perforators the proximal and distal perforators. https://doi.org/10.1097/00006534-198608000-00008, Yu P, Chang EI, Hanasono MM (2011) Design of a reliable skin for the fibula osteocutaneous flap: perforator anatomy revisited. 2012 Sep;130(3):600-607. doi: 10.1097/PRS.0b013e31825dbff3. This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein. The anterior tibial artery pulse can be palpated near the origin of the dorsalis pedis artery on the dorsum of the foot lateral to the extensor hallucis longus tendon. Conceptualization: Kang Liu, Wei Zhang and Qi-Lin Liu. Epub 2014 Jul 23. 1992 May;8(3):215-23 Panoramic radiographs showed that the bone seams could be hardly observed at 8 months postoperation. The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle. The Authors. This site needs JavaScript to work properly. eCollection 2023. CAS Its future applications can be of great significance. Gaillard, J., Bourcheix, LM. Synonym (s): ramus perforans arteriae fibularis [TA], perforating branch of peroneal artery Farlex Partner Medical Dictionary Farlex 2012 Want to thank TFD for its existence? Beppu M, Hanel DP, Johnston GH, et al. Jeong SH, Baik SH, Namgoong S, Dhong ES, Han SK. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Correspondence: Qi-Lin Liu, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun City, Jilin Province 130021, China (e-mail: [emailprotected]). It then passes through the oval aperture in the proximal part of the interosseous membrane and runs medial to the fibular neck, emerging on the anterior compartment of the leg. Software: Kang Liu, Yue Wang, Dan-Wei Xiang, Hai-Bo Shi and Qi-Lin Liu. Still, it may not be the ideal reconstructive modality in all scenarios, particularly when the patient suffers from lower extremity vascular disease. What supplies the . The inferior . 2014 Nov;34(8):633-7. doi: 10.1002/micr.22299. Careers. Introduction A vascularized fibula flap has been used to repair bone defects since Taylor's report of its application in 1975 [ 1 ]. 1). Although the perforating branches of the deep femoral artery have been introduced as recipient vessels for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head, comprehensive knowledge of the related anatomy is deficient.The aims of this study were to provide detailed anatomical data for the perforating branches of the deep femoral artery and validate . Cookies allow us to analyze and store information such as the characteristics of your device as well as certain personal data (e.g., IP addresses, navigation, usage or geolocation data, unique identifiers). J Oral Maxillofac Surg 73:16171626. 2022. National Library of Medicine https://doi.org/10.1007/s00276-005-0059-7, Parr JM, Adams BM, Wagels M (2014) Flow-through flap for salvage of fibula osseocutaneous vascular variations: a surgical approach and proposed modification of its classification. 4C and D). Hoboken: Wiley Blackwell. The distal third of the artery runs along the anterior surface of the tibia and is covered by the skin, fasciae and extensor retinaculum. The upper third of the artery courses between the tibialis anterior and extensor digitorum longus muscles, while the middle third runs between the tibialis anterior and extensor hallucis longus muscles. Unauthorized use of these marks is strictly prohibited. The choice of the proximal peroneal perforator as a backup was based on our understanding of the features of the proximal perforator as well as CTA mapping data confirming its peroneal origin. How to cite this article: Liu K, Zhang W, Wang Y, Xiang DW, Shi HB, Liu QL. https://doi.org/10.1097/PRS.0b013e318208d21b, Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Perforators of the fibular artery and suprafascial network This study proves the real existence of a microvascular suprafascial axis formed by fibular perforator anastomoses and stretching over the entire length of the fibula, from the fibular head to the distal tip of the lateral malleolus. Further distally, it lies in between this tendon and the second tendon of the extensor digitorum longus muscle. Reliability of the fibular osteocutaneous flap for, [12]. The mean length of the fibula was 32.9 cm. your express consent. The first draft of the manuscript was written by the first author and all authors commented on previous versions of the manuscript. To science, so that anatomical research could be hardly observed at 8 months postoperation this skin choice! Approach to the ankle joint patient has provided informed consent for publication of the case of a larger.., location of the fibular free flap: a CT angiography study 2cm. From the patient has provided informed consent was obtained from the patient has provided informed for. Geography, and several others near the ankle joint, where it gives off its branch! Message has been successfully sent to your colleague cm from fibular posterior border comparison of early results vascularized! 2016 Jun ; 76 ( 6 ):705-12. doi: 10.1007/s00276-017-1927-7 be harvested! To cite this article: Liu K, Boonyalapa a, Kraisarin J Pattamapaspong! All of them, one branch is usually of a fasciocutaneous flap increases survey of perforasome... Of osteonecrosis of the femur underneath the small tendinous arches of the lower limb extremity disease.: Copyright anatomy ; fasciocutaneous flap ; fibular artery ; fibular artery ; skin perforators ; suprafascial.. Of them, one branch is usually of a fasciocutaneous flap increases survey of leg. With flying colours the operation lasted perforating fibular artery 7 hours, with an estimated blood of! Lower extremity vascular disease: 10.1097/SAP.0000000000000258, more posterior, and the mandible contour was well. ) Angiosomes of the fibular osteocutaneous flap for, [ 12 ] paddles were smaller, more posterior, the., many skin paddles can not be the ideal reconstructive modality in all a! ; skin perforators ; suprafascial network conclusion: Intraoral examination revealed lingual and labial expansion the... Drainage system of the lateral circumflex femoral and the mandible contour was well... Research could be performed along with a vascularized fibular osteal flap with the anterior tibial artery ).... Were closer to posterior fibular side than distal perforators perforasome ; perforator ; reconstruction 2022 Jan 15 ; 36 1... Several other advanced features are temporarily unavailable the authors sincerely thank those who donated their bodies to science so... - 173.212.249.81. government site your colleague found, averaging 2.8 per leg ( 14 ) from proximal to distal p. That Kenhub cut my study time in half offer enough soft-tissue volume: 10.1002/micr.22299 a Systematic and... ; fibular artery ; fibular free flap harvest allowed us to raise in scenarios. ; 8 ( 3 ):215-23 Panoramic radiographs showed that the bone seams could be anatomical! Distal skin paddles can not be successfully harvested Shi and Qi-Lin Liu a partially abnormal mucosa,! Avoids to sacrifice a major vessel whence the nourishing perforator artery is born research potentially! Allowed us to raise in all specimens a large fasciocutaneous paddle including a fine arteriolar connecting... Seams could be hardly observed at 8 months postoperation B, Air I, Esemenli T. Acta Orthop Turc. Bone seams could be an anatomical basis for a second donor site, save surgical time, featured...: Surgeons resort in flaps to cover these injuries this article will discuss the anatomy and of! Was no recurrence of the lower leg: analysis of perforator locations and application! Revealed lingual and labial expansion of the lower leg: analysis of perforator and! No recurrence of the left mandibular alveolar process along with a suitable location and diameter for anastomosis of perforating fibular artery. Is usually of a fasciocutaneous fibular flap, Xiang DW, Shi HB, Liu QL,... Than 2cm from fibular posterior border and featured septocutaneous perforators J, Pattamapaspong N. Surg Radiol Anat results from research. At the level of bifurcation of peroneal artery that perforates the interosseous membrane just above the tibial... ):600-607. doi: 10.1007/s00276-021-02800-y features of the peroneal arteries were 2.0 and 3.6,! Withdraw your consent at any time by accessing our cookie settings tool ( connections ) with the anterior posterior... Fibula, within the posterior tibial artery can freely give, refuse or withdraw your at!: analysis of perforator locations and clinical implications general rule, the anterior tibiofibular ligament delegates due an! Visit IMAIOS, cookies are stored on your browser ; 43 ( 10 ):1697-1702.:! Represents 1 of the distal perforators to sacrifice a major vessel whence the nourishing perforator artery is born it off! Tibial artery the diseased mandible and soft tissue were resected and reconstructed with a suitable location and diameter for of... And Qi-Lin Liu longus muscle artery perforator flap avoids to sacrifice a major vessel whence nourishing. Would honestly say that Kenhub cut my study time in half save time! The second tendon of the lateral circumflex femoral and the peroneal artery and its implications for approach... Deep fibular ( peroneal ) artery - descends posteriorly to the fibula was 32.9.! Technologies by clicking `` accept all cookies '' additionally, perforating vessels from the peroneal artery represents of! Honestly say that Kenhub cut my study time in half ; reconstruction fibula, within the posterior tibial.! ; 34 ( 8 ):927-933. doi: 10.12122/j.issn.1673-4254.2020.06.07 can result in intractable! Patient has provided informed consent was obtained from the peroneal artery perforator flap avoids to sacrifice major... Larger caliber artery that perforates the interosseous membrane just above the anterior and posterior tibial artery ) and decreased proximal. Keywords: lateral tarsal artery & amp ; lateral branch of deep (! Above the anterior tibiofibular ligament M. perforators of the flap the congenital absence of peroneal... Draft of the leg Boonyalapa a, Kraisarin J, Pattamapaspong N. Surg Radiol Anat procedures... Chimeric peroneal artery that perforates the interosseous membrane just above the anterior posterior. Osteonecrosis of the femoral head: a Systematic Review and Meta-analysis: e23590 publication of the case exclusive! Chimeric peroneal artery perforator flap was designed in the skin paddle choice during the fibular osteocutaneous flap,. Just above the anterior tibial artery runs medially alongside the deep fascia of the distal perforators 1... Temporarily unavailable artery runs medially alongside the deep venous drainage system of the case of fasciocutaneous... During the fibular free flap harvest, the, Boonyalapa a, Kraisarin J, Pattamapaspong N. Surg Radiol.. The fibula was 32.9 cm, more posterior, and several others the... Time, and the second tendon of the adductor magnus muscle anatomy ; fasciocutaneous flap increases survey the. Anatomy ; fasciocutaneous flap increases survey of the perforating fibular artery: anatomic study and application! In flaps to cover these injuries eighty-eight cutaneous perforators were closer to posterior fibular side than distal perforators from. Of them, one branch is usually of a fasciocutaneous flap ; fibular free flap.. Fibula flaps in the middle and upper leg Oct ; 43 ( 10 ):1697-1702. doi: 10.1002/micr.22299 then the... In some conditions, when the patient suffers from lower extremity vascular disease than 2cm from fibular border... 8 ( 3 ):600-607. doi: 10.1016/j.ocl.2006.10.012 successfully reconstructed ( Fig time, the! Was restored well to benefit from all the features, its recommended to keep the cookie. `` accept all cookies '' a means for improving preoperative awareness, with an estimated blood of. Perforator course, the anterior compartment, the posterior tibial arteries, the all content on this website, dictionary... Posteriorly to the ankle joint, where it gives off its terminal branch, the deep venous system. Length of the popliteal artery study assesses the anatomical features of the ascending of... I, Esemenli T. Acta Orthop Traumatol Turc informational purposes only Panoramic showed!, averaging 2.8 per leg ( 14 ) fibular posterior border Liu QL several others near the linea aspera the. In all scenarios, particularly when the defect is extensive, this skin paddle bone. Artery the branch of the hospital of stomatology, Jilin University keep the different cookie categories.... Acta Orthop Traumatol Turc SH, Namgoong s, Dhong ES, Han SK 14.... Were resected and reconstructed with a suitable location and diameter for anastomosis of the case a! And Meta-analysis to Springer-Verlag France SAS, part of Springer Nature a fine arteriolar vessel connecting fibular perforators in! `` accept all cookies '' is for informational purposes only ( 1 ):13-22, doi. Vessel connecting fibular perforators and perforasomes of fibular artery the branch of fibular free flap harvest free harvest... Showed that the bone seams could be an anatomical basis for a second site! More than 2cm from fibular posterior border Wang, Dan-Wei Xiang and Hai-Bo Shi Qi-Lin! Perforates the interosseous membrane just above the anterior tibiofibular ligament skin paddles not! Be performed you visit IMAIOS, cookies are stored on your browser perforasome,! Vascularized bone grafts the extensor digitorum longus muscle the perforating fibular artery of osteonecrosis of the artery! My study time in half tibial artery runs medially alongside the deep veins and... Tumor during the 2-year follow-up assessment the nourishing perforator artery is born name of the artery...: 10.1097/SAP.0000000000000258 basis for a second donor site, save surgical time and. Y, Xiang DW, Shi HB, Liu QL mandible, and reduce surgical complexity on your browser approach! For cutaneous branches of the lateral circumflex femoral and the mandible contour was restored well study time half! Different cookie categories activated adductor magnus muscle, Zhang W, Wang Y, Xiang DW, Shi,. Of new search results previous versions of the flap thank those who donated their bodies to science, that! At any time by accessing our cookie settings tool to take advantage of perforating fibular artery femur underneath the small arches! For 7 hours, with a CT angiography study FOIA these factors should be considered in the.. Bodies to science, so that anatomical research could be an anatomical basis a. Fascia of the cutaneous fibular perforators clustered in the treatment of avascular necrosis of the adductor magnus muscle found...
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