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Surgical and Radiologic Anatomy

Published in:

01-04-2019 | Original Article

Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction

Authors: Lara Nokovitch, Julien Davrou, François Bidault, Bernard Devauchelle, Stéphanie Dakpé, Christian Vacher

Published in: Surgical and Radiologic Anatomy | Issue 4/2019

Abstract

Purpose

Initially described by Baudet in 1982, the fibula flap including the lateral head of the soleus muscle allows a one-stage reconstruction for large maxillo-mandibular defects. The aim of this study was to evaluate the number of muscular branches destined to the soleus muscle and their distance from the origin of the fibular artery, to assess the vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction.

Methods

We performed a cadaveric anatomic study on ten lower limbs, and a CT angiography anatomic study on 38 legs. The number of soleus branches originating from the fibular artery, and the distance between the origin of the fibular artery and each of the identified branches were measured.

Results

The number of soleus branches destined to the lateral head of the soleus muscle is variable, with in our study 1–3 branches found. Soleus branches destined to the lateral head of the soleus muscle emerged at a distance ranging between 0 and 2.9 cm (mean value = 1.82 cm) from the origin of the fibular artery in 40% of cases, between 3 and 5.9 cm (mean value = 4.27 cm) from the origin of the fibular artery in 37% of cases, and was at a distance of 6 cm or more (mean value = 6.93 cm) from the origin of the fibular artery in 20% of cases.

Conclusions

An origin of the soleus vessels in close proximity to the origin of the fibular artery represents the main limitation of this flap, the length of the remaining fibular pedicle making it difficult to achieve secure anastomosis in the cervical area. The vascular distribution of the proximal part of the lateral head of the soleus muscle being segmental, it is possible to lengthen the flap pedicle ligating the most proximal soleus branches originating from the fibular artery.

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Title: Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction
Authors: Lara Nokovitch
Julien Davrou
François Bidault
Bernard Devauchelle
Stéphanie Dakpé
Christian Vacher
Publication date: 01-04-2019
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 4/2019
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-018-2166-2

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Springer Medicine

Vascular anatomy of the free fibula flap including the lateral head of the soleus muscle applied to maxillo-mandibular reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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