Sound knowledge of the anatomical patterns of lower limb vasculature is crucial for raising the free fibula flap (FFF). The tibial arteries are particularly susceptible to anatomical variations with a dominant role of peroneal artery (PR) for lower leg perfusion, and hence precluding fibular flap harvest. In this systematic review we study the prevalence of lower limbs with dominant peroneal artery (dPR). A systematic review of the MEDLINE and EMBASE databases was conducted using a comprehensive combination of keywords and search algorithm according to PRISMA guidelines. Articles describing the branching patterns of lower limb arteries, in cadaveric or angiographic studies, were included. A total of 5,790 limbs were included from 26 studies. dPR was found in 5.2% of all limbs. The combination of dPR with hypoplastic or aplastic posterior tibial artery was the most common pattern (3.3%) followed by hypoplastic anterior tibial artery (1.5%). Peronea arteria magna (PAM) was seen in 0.4% of limbs. Bilateral variants were seen in 20% of all cases with a dPR. A greater awareness of dPR as anatomical variation and its prevalence among healthy subjects can prevent ischemic donor-site complications after FFF harvest. Clinical examination alone may not suffice to detect anatomical variations, hence preoperative imaging of lower limb vascular system is recommended.
Consideration of the individual orbital anatomy in the definition of outcome measures may improve the predictability of exophthalmos reduction in Graves' orbitopathy. Further clinical studies are required to determine the significance of intersubject variability in orbital morphology for the predictability of exophthalmos reduction.
The number of osseointegrated dental implants is increasing. Healthy peri-implant soft and hard tissues are required for the stability and survival of dental implants. In this paper we review factors that lead to peri-implant mucositis and peri-implantitis, and review treatment.
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