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Design of a Reliable Skin Paddle for the Fibula Osteocutaneous Flap: Perforator Anatomy Revisited

Yu, Peirong M.D.; Chang, Edward I. M.D.; Hanasono, Matthew M. M.D.

Plastic and Reconstructive Surgery: August 2011 - Volume 128 - Issue 2 - p 440-446
doi: 10.1097/PRS.0b013e31821e7058
Reconstructive: Head and Neck: Original Articles

Background: Designing a reliable fibula flap skin paddle can be challenging because of the lack of information on precise perforator locations. The purpose of this study was to precisely map the perforators and provide a simple and reliable method for skin paddle design.

Methods: Eighty consecutive patients undergoing free fibula flap reconstruction were included in this prospectively designed study. The location, size, and type of perforators were recorded intraoperatively and mapped on the line connecting the fibular head and lateral malleolus.

Results: There were 46 male and 34 female patients with a total of 202 perforators. The average length of the fibular head and lateral malleolus line was 36.1 ± 3.4 cm (male patients, 38.2 ± 2.2 cm; female patients, 34.1 ± 2.7 cm). Two discrete groups of perforators could be identified. The proximal perforator was consistently found one-third the length and 1.5 cm posterior to the line. The majority of these perforators (84 percent) were musculocutaneous. The more clinically useful perforators to support a skin paddle are the distal ones over the third quarter of the fibula. One to three distal perforators were consistently present, grouped as perforators A, B, and C at points 0.51, 0.62, and 0.73 along the line, respectively. Perforators were approximately 3.5 cm apart and 2 cm posterior to the line, and the majority (96 percent) were septocutaneous.

Conclusions: Using common anatomical landmarks, a reliable skin paddle can be designed with simplicity and confidence over the third quarter of the fibula. The proximal perforator can be useful as a second skin paddle for through-and-through reconstruction.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication December 31, 2010; accepted February 15, 2011.

Peirong Yu, M.D., Department of Plastic Surgery, Unit 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030,

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

©2011American Society of Plastic Surgeons