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Question 55#

Regarding free tissue transfer of the fibula bone:

A. In adults, the vascular pedicle to the fibula flap is usually limited in length to approximately 12cm
B. Arteria peronea magna is a relative contraindication to fibula flap harvest
C. The double-barrelled fibula flap configuration was first reported by Jupiter et al for long bone reconstruction
D. According to Mathes and Nahai, the fibula bone, like the pectoralis muscle, has a Type V vascular pattern
E. For mandibular reconstruction, bicortical screw fixation of the osteotomised free fibula is recommended over unicortical fixation for improved stability of the neomandible

Correct Answer is D

Comment:

According to Mathes and Nahai, the fibula bone, like the pectoralis muscle, has a Type V vascular pattern. The length of the pedicle to the fibula flap depends on the site of the proximal osteotomy rather than the length of the peroneal vessels from their origin to the tibial side of the bone. Along the fibula, the pedicle must be dissected in a subperiosteal plane to preserve bone vascularity. Arteria peronea magna is an absolute contraindication to free fibula flap harvest due to the risk of foot devascularisation. The double-barrelled fibula flap configuration was first described by Yoo et al 1; Jupiter et al 2 published their report some 5 years later. The fibula bone has a Mathes and Nahai Type V pattern of circulation; their classification is not limited to muscles and muscle-containing flaps. Unicortical screw fixation of the osteotomised free fibula is recommended over bicortical fixation to safeguard the periosteal blood supply to the bone.

References:

1. Yoo MC, et al. Free vascularized fibular graft using microsurgical technique. J Korean Orthop Assoc 1982; 17: 403.
2. Jupiter JB, Bour CJ, May JW. The reconstruction of defects in the femoral shaft with vascularized transfers of fibular bone. J Bone Joint Surg [Am] 1987; 69: 365-74.