Μελέτη της αγγείωσης του οστεοδερματικού κρημνού της περόνης
Authors: Παπαδήμας Δημήτριος 
Published: January 2014

The fibular flap was first described in 1975 by Taylor et al. for reconstruction of large bony defects. In 1983, Chen and Yan first described the osteocutaneous fibular flap and later Hidalgo et al. were the first who used the osteocutaneous free fibular flap in mandibular reconstruction. Furthermore the osteocutaneous free fibular flap has been successfully used in the reconstruction of the metatarsal after the resection of malignant tumors, in the reconstruction of the velopharyngeal competence after the resection of tumors, in the treatment of the atrophy of the maxilla, in the reconstruction of the spine after the resection of tumors or for the treatment of the severe cyphosis due to arthritis, neurofibromatosis or tuberculosis. The incorporation of the skin island in the free fibular flap has also allowed the use of the flap in the simultaneous one-stage reconstruction of the posterior pharyngeal wall and the cervical spine. Another application of the free fibular flap is in the reconstruction of the pelvic ring after large bony defects. The sensate osteocutanous free fibular flap has been also used in the penile reconstruction. Although the iliac crest, the scapulae, the ribs, the metatarsals and the radius have been used for reconstruction of mandibular defects, the bone that best matches the biomechanical properties of the mandible is the fibula. The fibula provides also up to 25 cm of solid bone enough to reconstruct any length of mandibular defect and capable of supporting dental implants. Furthermore, it allows the simultaneous approach of two operating teams reducing the operating time and the postoperative morbidity is considered to be low. Today the osteocutaneous free fibular flap represents the most popular procedure in the reconstruction of composite mandibular defects. In the beginning the free fibular flap was used in the reconstruction of extensive long-bone defects after tumor ablation or posttraumatic This study was performed on 15 formalin preserved adult cadavers with an age ranging between 52 and 94 years. The lower extremities of each cadaver were dissected bilaterally. The dissection was focused on the perforator arteries that penetrate the crural fascia, ending in the skin centered over the posterolateral intermuscular septum of the leg and over the skin of the lateral edge of the soleus muscle (SM). A large incision was made in the skin along the peroneous longus muscle (PLM), parallel to the fibula from the fibular head to the lateral malleolus, 2 cm in front of the posterior edge of the fibula. A skin flap was elevated in the deep fascial plane at a width of 5 cm around the posterior border of the fibula. The crural fascia was incised according to the skin incision and the perforators were dissected towards their source artery. We studied only the perforators of the PA that had an external diameter greater than 0.3 mm at the fascia penetration site. We recorded the number of the perforators, their location relative to the fibula, their course and their diameter at the fascia penetration site. The distance between the posterior margin of the fibula and the point of emergence of the artery from the fascia was measured. Additionally, the diameter of the anterior tibial artery (ATA), the posterior tibial artery (PTA), the PA correspondingly to their branching site, as well as the diameter of the popliteal artery (POPA) correspondingly to the head of the fibula were determined. Finally, the distance between the head of the fibula and the branching site of the ATA and the distance between the head of the fibula and the bifurcation site of the tibioperoneal trunk (TPT) were recorded. Transverse sections from each vessel were routinely stained with hematoxylin-eosin. Slides were digitized under 20x magnification by the use of a Nikon Eclipse 80i light microscope (Nikon Corp, Tokyo, Japan) equipped with a digital camera (Nikon DS-2MW). Digital images were processed with the appropriate software (Image ProPlus v5.1, Media Cybernetics, MD, USA) in order to measure the diameter of each vessel. ......................................................................................................................................