Applied anatomy of the V-shaped fibular osteomyocutaneous flap in reconstruction of the hindfoot

Abstract To establish the applied anatomy of the V-shaped fibular osteomyocutaneous flap pedicled on the peroneal vessels, cadaver dissections were made in 60 lower limbs and 40 calcanei were examined to sum up the features of calcaneal biomechanics on the stability of the foot and the blood supply of the fibular osteomyocutaneous flap. There were four anastomoses and large communicating branches between the lower segment of the peroneal artery and the anterior and posterior tibial arteries. The flap was well supplied by a retrograde circulation through these anastomoses. A suitable length of pedicle was 20 cm. In the sagittal section of the calcaneus passing through the center of the articular surface for the cuboid bone, the arrangement of the trabeculae formed a triangular zone. The V-shaped flap corresponds nicely with the calculated lines of stress evoked by the weight of the body. The procedure may provide a new method for hindfoot reconstruction. This flap meets the criteria outlined for composite tissue reconstruction of defects of the extremities and biomechanics of the hindfoot, especially for calcaneal and cuboid defects.