2018 Volume 27 Issue 4 Pages 287-294
Free vascularized fibular flaps (FVFF) have an advantage in their applicability for extensive bone defects in the maxillofacial region after surgery, and have therefore been employed in maxillofacial reconstruction in Western countries. For successful application of FVFF, anatomical understanding of the fibula is necessary. Many studies on the fibula of patients and autopsied bodies have been reported. An increase in demand is predicted in Japan, but few studies on the morphological characteristics of the fibula of Japanese have been reported. Many unclear points remain and no study has focused on sex differences. In this study, the 3-dimensional morphology of the fibula of Japanese was observed, the previously unreported distribution and location of the feeding blood vessels were examined, and the region containing sufficient bone mass for maxillofacial reconstruction was anatomically evaluated. Images of the excised fibula were acquired using CT for medical use and subjected to 3-dimensional reconstruction. Prior to measurement, the fibula was divided into 6 parts between the apex of the fibular head and apex of the lateral malleolus. The 4 central regions were set as regions of interest and the diameters of the fibular cross sections were 3-dimensionallymeasured. In addition, the distribution of the feeding blood vessels to the fibula was macroscopically observed and classified. On 3-dimensional bone morphology measurement, the width (diameter) of fibula cross section between the anterior margin and posterior aspect was the largest, followed by that between the medial crest and lateral aspect. In the regions of interest, the mean width between the anterior margin and posterior aspect, which corresponded to the grafted bone height, exceeded 10 mm, and the mean width between the medial crest and lateral aspect and between the posterior margin and medial aspect, which became the buccolingual width of the grafted bone, exceeded 6 mm, confirming that the graft thickness is sufficient for grafting. Furthermore, the blood vessels feeding the fibula entered the bone in the central one-third region in all preparations. Inclusion of the central one-third region was suggested to be effective for vascularized fibular grafting.
