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The Fibula Osteoseptocutaneous Flap Incorporating the Hemisoleus Muscle for Complex Head and Neck Defects: Anatomical Study and Clinical Applications

Wong, Chin-Ho, M.R.C.S., F.A.M.S.(Plast. Surg.); Ong, Yee-Siang, M.R.C.S., F.A.M.S.(Plast. Surg.); Chew, Khong-Yik, M.R.C.S.; Tan, Bien-Keem, F.R.C.S., F.A.M.S.(Plast. Surg.); Song, Colin, F.R.C.S., F.A.M.S.(Plast. Surg.)

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 1956-1964
doi: 10.1097/PRS.0b013e3181bf83b0
RECONSTRUCTIVE: HEAD AND NECK: ORIGINAL ARTICLES
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Background: In patients with extensive bone and soft-tissue defects, the inclusion of the hemisoleus muscle with the fibula osteoseptocutaneous flap would provide the needed soft-tissue volume to the flap. This study evaluates the reliability and technical considerations for the inclusion of the hemisoleus with the fibula and skin paddle as a chimeric, peroneal artery–based flap.

Methods: The location and size of major arterial branches of the peroneal artery supplying the lateral hemisoleus muscle were investigated in 10 cadaveric injected lower limb specimens. The utility of this design was demonstrated in five clinical cases.

Results: The lateral hemisoleus was noted to be consistently supplied by large muscle branches from the peroneal artery, soleus vessels 1 (proximal) and 2 (distal). The mean diameter and distance from the origin of the peroneal artery for soleus vessels 1 and 2 were 1.8 mm and 2.1 cm, and 1.6 mm and 6.3 cm, respectively. The fibula osteoseptocutaneous flap incorporating the hemisoleus muscle was performed in five clinical cases. All were successful. Either soleus vessel 1 or soleus vessel 2 can be used as the pedicle to the muscle, depending on the specific reconstructive requirements for the reach and placement of the hemisoleus.

Conclusions: The fibula osteoseptocutaneous flap incorporating the hemisoleus muscle can reliably be raised by preserving constant muscle branches that arise from the peroneal artery to supply the lateral hemisoleus. This flap provides the additional bulk in selected cases, with little additional donor-site morbidity.

Singapore

From the Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital.

Received for publication April 26, 2009; accepted May 27, 2009.

Disclosures:None of the authors has any conflict of interest regarding the content of this article.

Chin-Ho Wong, M.R.C.S., F.A.M.S.(Plast. Surg.), Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, 169608 Singapore, wchinho@hotmail.com

©2009American Society of Plastic Surgeons