Vascular Anomaly in Fibular Flap Candidate-Report of Four Cases

腓骨游離皮瓣供區血管變異－四病例報告

連凱華(Kai-Hua Lien) ； 劉定國(Ting-Kuo Liu) ； 吳家佑(Chia-Yu Wu)

《臺灣口腔顎面外科學會雜誌》 30卷4期 (2019/12) Pp. 245-251

摘要

Free fibular flap (FFF) is the microsurgeon's workhorse for the reconstruction of osseous or osteocutaneous defects. There are some vascular anomalies in the branching of the popliteal artery, and were categorized into 3 types with 10 groups according to the classification by Kim et al. For patients of type III-A and III-B, FFF harvest may be dangerous for donor site due to the result of single-vessel leg. For patients of type III-C, FFF harvest is contraindicated because it would result in foot ischemia or limb loss. Preoperative evaluation of the anatomical variations is crucial for preventing jeopardizing the donor leg. Computed tomographic angiography (CTA) is one of the useful tools in evaluating the peripheral arterial system with high sensitivity and specificity. We present four cases of head and neck cancer patient s, in whom vascular anomalies in lower limbs (two III-A, and two III-B) were found in CTA examination before reconstructive surgery. The treatment plans were re-evaluated then, and the surgeries were performed smoothly. CTA, magnetic resonance angiogram, angiography, and color doppler ultrasonography are useful in detecting these vascular variations, and we strongly recommend choosing one to perform before FFF surgery.

關鍵字

Free fibular flap ； Microsurgery ； Vascular anomaly ； Popliteal artery ； Computed tomographic angiography

並列摘要

腓骨游離皮瓣常用於頭頸部之重建手術。膕動脈分支的型態變異被分成三大類以及十個亞型。取腓骨游離皮瓣，會造成III-A及III-B變異之小腿僅剩一條主要動脈，或使III-C變異之小腿壞死。術前檢查血管變異可以避免危及供給區之血液供應，而電腦斷層血管攝影為一良好的檢查方式。此文章提出四例病例報告，於腓骨游離皮瓣術前之電腦斷層血管攝影中發現有兩例III-A及兩例III-B之變異型態，評估後選擇對側下肢順利重建。電腦斷層血管攝影、核磁共振造影血管攝影、血管攝影術，以及彩色杜卜勒超音波皆為有效評估血管變異之方式，我們強烈建議於腓骨游離皮辨重建手術前選擇其一評估，以提升供給區之安全性。

並列關鍵字

腓骨游離皮瓣 ； 顯微重建手術 ； 血管變異 ； 膕動脈 ； 電腦斷層血管 ； 攝影