[Applied anatomy of compound flap based on fibular head to rebuild defects of internal malleolus].
OBJECTIVE
To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus.


METHODS
The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were listed as follows: 1) Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; 2) Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; 3) Thirty adult lower limb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site.


RESULTS
The internal malleolus had a basilar width of (2.6 +/- 0.2) cm, a middle thickness of (1.3 +/- 0.2) cm, an anterior length of (1.4 +/- 1.9) cm and a posterior length of (0.6 +/- 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 +/- 3.60) degrees. The fibular head had a middle thickness of (1.8 +/- 0.6) cm, a middle width of (2.7 +/- 0.4) cm. Its articular facet was toroid, superficial and cavae in shape, and exposed inwardly and upwardly, and had a extraversion angel of (39.2 +/- 1.3) degrees. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 +/- 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 +/- 0.2) cm and a outer diameter of (2.0 +/- 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 +/- 0.5) mm and (2.6 +/- 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 +/- 1.3) mm at (1.0 +/- 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 +/- 0.4) mm. Its accompanying veins had outer diameters of (1.3 +/- 0.5) mm and (1.1 +/- 0.4) mm.


CONCLUSIONS
The blood supply compound flap based on fibular head had a possibility to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
Zhang
Fahui
F
Research Center of Clinical Anatomic, Military Institute of Orthopedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou Fujian, 350003, PR China. zfh4865@163.com
Wu
Shuipei
S
D000328:Adult; D000842:Ankle / Q000033:anatomy & histology*; D016512:Ankle Injuries / Q000601:surgery; D005360:Fibula / Q000033:anatomy & histology* / Q000637:transplantation; D006801:Humans; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000098:blood supply; D013977:Tibia / Q000033:anatomy & histology; D016909:Tibial Arteries / Q000033:anatomy & histology*