There are speculations that the proximal third fibular osseosomes, supplied by the anterior tibial vessels cannot be reliably recruited on the peroneal vessels supplying fibular diaphyseal osseosomes. Anatomical study by the authors eschewed this speculation and paved way for an evidence-based surgery. Cadaveric dissection, dye injection, and radiological studies revealed existence of a reliable anastomotic musculoperiosteal vessel between these two osseosomes that could effectively recruit the proximal fibular osseosomes on the peroneal vessels. Also, operative tips and tricks for safeguarding these anastomotic vessels were defined by the cadaveric study. Aesthetic and functional outcomes were assessed in five clinical cases, where the fibular heads were harvested reliably on the peroneal pedicle and stable wrist joints were reconstructed following oncological excisions.
Based on the evidence from the anatomical study, five clinical cases (three males and two females) affected by stage III GCT (giant cell tumor) of distal radius underwent microvascular fibular head hemiarthroplasty following tumor excision. Average follow-up of the patients was 18 months.
At the end of follow-up period, all patients had an average MSTS (Musculoskeletal Tumor Society) score of 23. Scores ranged from 21 to 25. Patients had good functional outcomes with 69% average mobility in the reconstructed wrist when compared with the opposite normal wrist. Aesthesis of the reconstructed wrists were acceptable.
The cadaveric study demonstrated concrete anatomical evidence of existence of an anastomotic musculoperiosteal vessel between anterior tibial and peroneal fibular osseosomes in all the specimens. Clinical study validated the safety of the vascularized proximal fibular hemiarthroplasty on peroneal pedicle. It may be a reliable method for reconstruction of the radiocarpal joint in the post-GCT distal radius excision with good aesthetic and functional outcomes.
Level of Evidence: Level V, therapeutic study
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The authors thank Prof. Sudha Seshayyan, MS (Anatomy), director of Institute of Anatomy Madras Medical College, for her support and guidance in the anatomical study.
Conflict of interest
Balakrishnan Thalaivirithan Margabandu, J. C. Charan and J. Jaganmohan declare that they have no conflicts of interest.
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Thalaivirithan Margabandu, B., Charan, J.C. & Jaganmohan, J. An anatomical study of vascular communications between anterior tibial and peroneal osseosomes and its clinical application in proximal hemiarthroplasty of radiocarpal joint following tumor excision. Eur J Plast Surg 42, 273–281 (2019). https://doi.org/10.1007/s00238-018-1482-4
- Microvascular proximal fibula hemiarthroplasty of radiocarpal joint
- Anterior tibial fibular osseosomes
- Peroneal fibular osseosomes
- Anastomotic musculoperiosteal vessel
- Distal end radius GCT