Possibility of Venou Return Through Bone Marrow in the Free Fibular Osteocutaneous Flap

Abstract

The authors report a case of a free fibular graft that was successful as a result of venous return delivered through the bone marrow. A 26-year-old man underwent reconstruction of the left tibia and a soft-tissue defect of the lower leg. A free vascularized fibular bone and skin flap was elevated. The fibular vessels were anastomosed to the dorsalis pedis vessels. The elevated fibular bone was fixed to the tibia. The next day, reanastomosis was necessary because of venous thrombosis. However, the fibular vein rethrombosed, but blood flow was ascertained by Doppler flowmetry, with darker blood flow being recognized from the edge of the flap. Four days after surgery, the skin color gradually improved, and the flap had almost completely taken. On retrospective evaluation, the authors concluded that this flap succeeded because venous return was routed through the bone marrow in the free fibular graft.

A new porcine vascularized tibial bone allotransplantation model. Anatomy and surgical technique

“…Arterial nutrient pedicle diameter and length were sufficient for microsurgical tibial transfer as a vascularized allotransplant. Venous anastomosis was not performed since others have provided both clinical and experimental evidence demonstrating fibula and other bone flaps to survive by outflow through the medullary canal (Kamei et al, ; Tanaka et al, ).…”

Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

“…The authors presumed that bone marrow is the root of venous drainage. [20][21][22] Sensory recovery is also excellent. Painful sensation usually disappears within 1 month and protective sensation is restored within 6 to 12 months.…”

Tamai zone I fingertip replantation: Is external bleeding obligatory for survival of artery anastomosis‐only replanted digits?

“…They concluded that bone marrow plays a critical role in venous drainage until the cutaneous venous system regenerates . Bone marrow as a means of venous drainage in the flap surgery was first described by Chen et al Kamei used the same protocol for another case of survived fibula osteocutaneous flap in 2001 . Although there are only two case reports, Tamai zone I amputated part with a small amount of tissue has more chance of survival with the aid of bone marrow drainage.…”