Topographical relationship between cutaneous and osteonutrient arterial branches of the peroneal artery: a...

For the total procedure of the fibular osteocutaneous flap in which a part of the fibula and its covering skin and fascia are grafted, the authors conjectured that the complete preservation of the osteonutrient arterial branch of the peroneal artery is essential in order to maintain good perfusion of the grafted fibula. The aim of this study is to clarify the morphometrical relationship between the cutaneous (C) and osteonutrient (OS) arterial branches of the peroneal artery in order to re-examine the procedure. One hundred cadavers were dissected minutely and examined morphometrically. 1. At the middle third of the leg, the OS branch frequently (64.5%) arose from the peroneal artery at a close position (0-10 mm) to the origin of one of the C branches. Moreover, the OS and C branches often (35.4%) formed a common trunk. 2. In several C branches in one leg, the C branch which existed closest to the OS branch showed a relatively larger diameter. In the case where two or three C branches were found, the closest C branch was most likely to be the uppermost one of them. When four or more C branches were found, the middle one tended to be the closest C branch. Consequently, we recommended that the flap be designed using both the middle part of the fibula and the skin at the proximal 30-50% level of the leg, and that the peroneal arterial trunk be attached to the fibula at the minimum 30-50% level of the leg in order to guard the OS branch.