Fibula Flap Flashcards
Articulations of fibula
Lateral condyle of tibia
- No knee joint component
Ankle
- Distal end of fibula forms malleolus that articulates medially with talus.
What happens to posterior intermuscular septum when soleus muscle harvested
Septum is harvested in continuity with paddle of skin and fascial of lateral leg
Which free flap is highly tolerant of radiation therapy
Radial forearm flap
What length of proximal and distal fibula is kept intact for knee/ankle
6cm
Innervation of fibula flap
Common peroneal –> Lateral sural (calf) cutaneous n.
Blood supply to skin paddle
Intramuscular (sometimes septocutaneous) perforators from peroneal artery
Sequence to identify fibula perforators
- First look for septal perforators to skin from anterior approach (between muscle and muscle fascia, retracting muscle posteriorly to visualize interosseus septum (membrane)
- If no septal perforators then posterior approach to identify intermuscular perforators.
Minimum fibula segments
Rodriguez = 2.5cm (perforators feed periosteum feed bone)
Peroneal artery proximal branches
- AA
- Common illiac
- External illiac
- Common femoral
- Superficial femoral
- Popliteal (within knee joint)
- Branches x3
- Anterior tibial –> dorsalis pedis
- Peroneal (terminal)
- Posterior tibial –> plantar arteries
Flaps for mandible recon
- Fibula
- Scapula
- Iliac crest
Fibula vessels
Peroneal artery + concomitant veins x2
Compartments of lower leg distal to neck of fibula
4 compartments
- Anterior
- Lateral
- Superficial posterior
- Deep posterior
FFF Pedicle length
12cm
Maximum length of vascularized bone from FFF
25cm
Reconstruction Ladder/Elevator
Simple –> Complex
- Free flap
- Regional flap
- Local flap
- Skin graft
- Primary closure
- Secondary healing