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Free Flaps > Fibula Flap > Flashcards

Fibula Flap Flashcards

1
Q

Articulations of fibula

A

Lateral condyle of tibia

  • No knee joint component

Ankle

  • Distal end of fibula forms malleolus that articulates medially with talus.
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2
Q

What happens to posterior intermuscular septum when soleus muscle harvested

A

Septum is harvested in continuity with paddle of skin and fascial of lateral leg

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3
Q

Which free flap is highly tolerant of radiation therapy

A

Radial forearm flap

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4
Q

What length of proximal and distal fibula is kept intact for knee/ankle

A

6cm

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5
Q

Innervation of fibula flap

A

Common peroneal –> Lateral sural (calf) cutaneous n.

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6
Q

Blood supply to skin paddle

A

Intramuscular (sometimes septocutaneous) perforators from peroneal artery

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7
Q

Sequence to identify fibula perforators

A
  1. First look for septal perforators to skin from anterior approach (between muscle and muscle fascia, retracting muscle posteriorly to visualize interosseus septum (membrane)
  2. If no septal perforators then posterior approach to identify intermuscular perforators.
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8
Q

Minimum fibula segments

A

Rodriguez = 2.5cm (perforators feed periosteum feed bone)

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9
Q

Peroneal artery proximal branches

A
  1. AA
  2. Common illiac
  3. External illiac
  4. Common femoral
  5. Superficial femoral
  6. Popliteal (within knee joint)
  7. Branches x3
  • Anterior tibial –> dorsalis pedis
  • Peroneal (terminal)
  • Posterior tibial –> plantar arteries
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10
Q

Flaps for mandible recon

A
  • Fibula
  • Scapula
  • Iliac crest
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11
Q

Fibula vessels

A

Peroneal artery + concomitant veins x2

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12
Q

Compartments of lower leg distal to neck of fibula

A

4 compartments

  1. Anterior
  2. Lateral
  3. Superficial posterior
  4. Deep posterior
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13
Q

FFF Pedicle length

A

12cm

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14
Q

Maximum length of vascularized bone from FFF

A

25cm

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15
Q

Reconstruction Ladder/Elevator

A

Simple –> Complex

  • Free flap
  • Regional flap
  • Local flap
  • Skin graft
  • Primary closure
  • Secondary healing
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16
Q

Anterior fibula muscles (Extensors)

A

Proximal to distal

  1. Insertion of biceps femoris
  2. Peroneus (Fibularis) longus
  3. Extensor digitorum longus
  4. Extensor hallucis longus
  5. Peroneus (Fibularis) brevis
17
Q

Indications for mandible recon with free tissue transfer

A

>6cm defect H/o XRT Osteomyelitis

18
Q

Physical exam pearls preop assessment

A

Examine feet for signs of PVD

Palbable posterior/anterior tibial pulses

Modified allen’s (eval palbable pulse of anterior when compressing posterior, vice versa)

19
Q

Caliber of peroneal artery

A

Large caliber 1.5-4mm

20
Q

Maximum width of fibula skin paddle that can be closed primarily

A

5cm

21
Q

How many surfaces does the fibula have?

A

4

22
Q

Relationship of fibula vessels to fibula

A

Posteromedial aspect of fibula

23
Q

Peroneal artery distal branches

A

No named branches. Only anterior tibial and posterior tibial arteries

24
Q

How can the FFF pedicle be lengthened?

A

Dissect pedicle free from proximal fibula and use distal bone for reconstruction

25
Q

Relationship of common peroneal nerve to fibula

A

Loops around fibular neck.

26
Q

Preop planning factors with free flaps

A
  1. Amount and type of tissue at defect 2. PSH or injury at donor site 3. Donor morbidity 4. Patient positioning and donor location 5. Need for carotid coverage 6. General Med status 7. Hypercoag work-up
27
Q

The skin paddle (island) axis can be marked posterior or anterior to axis of the bone?

A

Posterior

28
Q

Year and Pioneer of fibula flap

A

Taylor 1975 Hidalgo, 1989

29
Q

Shape of fibula in crossection

A

Triangular

30
Q

What separates the lateral compartment from the soleus muscle

A

Posterior intermuscular septum

31
Q

Recipient site arteries for FFF

A
  • Facial
  • Superior thyroid
  • Superficial temporal (spared by radiation, reliable)
  • Transverse cervical
32
Q

(Flexors) Posterior Fibula muscle attachments

A

Proximal to distal

  1. Soleus
  2. Tibialis posterior
  3. Flexor hallucis longus
33
Q

What thickness of muscle cuff is required to protect fibula bone flap

A

1-2mm

Free Flaps (2 decks)

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