| Chapter I Applied anatomy of Mosaic of the adult free fibulaflap and the peroneal artery perforator flapObjective To crystallize coursrs,numbers, distributions, pedicle lengths, externaldiameter and the position of perforators of the peroneal artery flap perforators and bonego line rule, then to provide anatomical basis for the application of Mosaic of the adultfree fibula flap and the peroneal artery flap.Methods Twenty fresh specimens of adult leg with knee joint injected with red latexwere dissected.Fibulas were divided into three sections.Distribution, numbers, pediclelength excernal, diameters,courses and relations of peroneal artery skin perforators andbone perforators in each section were observed,as well as measured and analyzed.Results The peroneal artery began to adhere fibula and give the perforators7.23±3.76cm under fibular head. The skin perforators and the bone perforators constantlyappeared in the midpiece of legs.In this section, numbers of perforators were the largestwith5±1branch respectively; diameters were widest with1.12±0.56mm for skinperforators and0.82±0.44mm for bone perforators. Skin perforators vascular pediclewas6.38±1.72cm long. the skin perforators and bone perforators of the peroneal arteryalmost appeared in different position.Conclusions Bone and skin perforators of peroneal artery shared the same trunk andmoderatly separated, characterized by chimeric flap anatomical features,which weresuitable for designning the fibula flap Mosaic of the peroneal artery flap. Chapter II Clinical application of mosaic of the free fibulaflap and the peroneal artery perforator flapObjective To explore the feasibility of Mosaic of the free fibula flap and theperoneal artery perforator flap to repair bone defect with or without skin and soft tissuedefects, and to analyze its clinical effect.Method10patients who had Bone defects with or without skin and soft tissuedefects had been treated repairs with Mosaic of the free fibula flap and the peroneal arteryperforator flap from June2010to October2012. outward appearance,wound healinganddonor site complications of skin flap and bone flap obserred during postoperative follow-up. This group of patients was set to be a study group.10patients of bone defects beforeJune2010, with or without skin and soft tissue defects, who had adopted the traditionalfibula flap operation was set to be the control group. Survival flap appearance, bone flaphealing time and donor site postoperative complications of the two groups were compared.Results Study Group:10cases of flaps all survived, including9cases of phase Ihealing completely,1case of skin flap necrosis edges which healed after dressing changewith satisfactory skin flap appearance.1case a bit bloated, linear scar was left with directsuture in7cases of direct suture,3cases of skin graft survival,4cases of mildcomplications. Bone flap healing time was7.18±1.01months. Control group included6cases of postoperative flap completely healing,2cases of complete skin flap necrosiswhich healed by using other skin flap to repair of2cases of skin flap necrosis and healingafter dressing change,7cases directly suture with linear scars,3cases of skin graftsurvival,6cases different degree of complication with unsatisfactory function. Bone flaphealing time was7.05±1.43months.postoperative complications of different levelappeared in two cases, of which severe complications with unsatisfactory functionappeared in two cases. Two groups of patients were statistically analyed flom theperspectives of healing time of the bone flap, flap necrosis rate, flap bloating rate, donorsite complications.Bone flap healing time was recorded by T test,P value is greater than0.05, without statistical significance. skin flap necrosis rate and skin flap bloating rateweretested by chis quare test, P values were less than0.05, with statistical significance.Conclusions Mosaic of Free fibula flap and the peroneal artery perforators flapseparate the bone flap and skin flap is effectively, resulting in more flexible repair, lessrisk of vascular pedicle pressfitting and more satisfactory flap survival, which becomes one of the best choice for the clinical repair of bone defects with or without skin and softtissue defect. |
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