title: Osteotomising the fibular free flap: an anatomical perspective.
abstract: Multiple osteotomies with the help of 3-dimensional planning have improved the accuracy of reconstructions, and the reliability and versatility of the fibular free flap is well recognised. To investigate the periosteal blood supply of the fibula and to define safe limits for the size of bony segments, we performed a cadaveric study on 10 fresh frozen lower limbs using a combined barium latex mixture. We modelled cuts at intervals of 1.0, 1.5, and 2.0cm, and assessed the number of periosteal vessels. After virtual dissections using DICOM data obtained from high-resolution computed tomograms (CT), on average we found 12.8 periosteal branches, with a mean (SD) distance between them of 1.36 (0.18)cm. In 34.9% of the 1cm segments there were no visible periosteal vessels. Vascularity seemed to be more reliable in longer segments, with 83.4% of those 1.5cm long, and 94% of those of over 2cm containing at least one branch.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sheffield, Teaching Hospitals NHS Foundation Trust, Charles Clifford Dental Hospital, 76 Wellesley Rd, Sheffield, South Yorkshire S10 2SZ. Electronic address: amfry79@gmail.com.
authors.forename: A M
authors.initials: AM
authors.lastname: Fry
authors.affiliation: Department of Oral and Maxillofacial Surgery, Royal Derby Hospital, Uttoxeter New Road, Derby DE22 3NE.
authors.forename: Dave
authors.initials: D
authors.lastname: Laugharne
authors.affiliation: Department of Oral and Maxillofacial Surgery, Royal Derby Hospital, Uttoxeter New Road, Derby DE22 3NE.
authors.forename: Keith
authors.initials: K
authors.lastname: Jones
mesh_terms: D016025:Bone Transplantation; D002102:Cadaver; D005360:Fibula / Q000098:blood supply*; D058752:Free Tissue Flaps; D006801:Humans; D010027:Osteotomy; D019651:Plastic Surgery Procedures; D015203:Reproducibility of Results
keywords: Anatomy; Fibular; Oncology; Reconstruction