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Background Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. Methods Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated. Results In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4–2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3–3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18–58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48–105 cm3). Conclusion Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.

Background The study investigated the anatomy of the retroauricular lymph node (LN) flap and evaluate its surgical feasibility as a new donor site for a free LN flap in lymphedema surgery. Methods Twelve adult cadavers were examined. The course and perfusion of the anterior auricular artery (AAA) and the location and sizes of the retroauricular LNs were studied. Results The AAA was available in 87% and absent in 13% specimens. The AAA's origin had a mean vertical distance of 12.2 ± 6.9 mm and a mean horizontal distance of 19.1 ± 4.2 mm from the superior attachment of the ear. The mean diameter of the AAA was 0.8 ± 0.2 mm. The mean number of LN per region was 7.7 ± 2.3, with an average LN size of 4.1 ± 1.9 × 3.2 ± 1.7 mm. The LN were categorized into anterior (G1) and posterior (G2) groups, with a total of 59 and 10 LN, respectively. In a cluster analysis, three LN clusters could be detected across the anterior group (G1). Conclusions The retroauricular LN flap is a delicate but feasible flap with reliable anatomy, containing a mean of 7.7 LNs.

ZusammenfassungIm Frühstadium von Nervenläsionen stellt die klinische Differenzierung zwischen Neurapraxie, Axonotmesis und Neurotmesis oftmals eine große Herausforderung dar. Vor allem im Frühstadium von Nervenläsionen ist eine korrekte Klassifizierung des Schädigungstyps jedoch von essenzieller Bedeutung, da hiermit das therapeutische Konzept, insbesondere das operative Vorgehen und damit die Prognose, maßgebend bestimmt werden. Neben einer ausführlichen klinischen Statuierung und Anamneseerhebung bedarf es zur Präzisierung der Diagnose den Einsatz ergänzender elektrophysiologischer (funktioneller) und/oder bildgebender Untersuchungen. Eine elektrophysiologische Diagnostik kann hierbei Auskunft über Lokalisation, Schweregrad, Verlauf, Schädigungstyp und einer beginnenden oder stattgehabten Reinnervation geben. Präoperativ sollten hinsichtlich der funktionellen Diagnostik eine Neurografie, Nadel-Elektromyografie (EMG) und ggf. evozierte Potentiale (EP) und bildgebend eine Nervensonografie oder Magnetresonanztomografie (MRT) durchgeführt werden. Ergänzend kann eine EMG auch intraoperativ erfolgen.