40多年来，游离腓骨瓣一直通过“侧向入路”从腓骨肌后缘提起。然而，在这种方法中，手术视野受到限制，因为下颌重建中的皮瓣抬高是与仰卧位的肿瘤切除同时进行的，即使使用定位枕头也是如此。我们在此提出“前路入路”作为一种新的手术方法。我们回顾性研究了七年期间使用前入路（包括三个前入路）进行的游离腓骨瓣手术。首先，为了避开腓浅神经的走行，在腓肌前缘后方1-2cm处切开小腿筋膜。腓骨肌的前缘与前肌间隔分离。在腓骨远端和近端进行截骨后，从前面切开骨间膜。将腓骨拉至前肌间隔与腓骨肌之间的前间隙，使手术视野变浅。 55例患者术后均未发现腓浅神经或深神经麻痹。 55例中31例（56.4%）仅使用一根止血带，平均95分钟。 24 名患者 (43.6%) 在间隔 38 分钟后需要第二次止血带。过去3年的30例病例中，有25例（83.3%）仅使用了一根止血带。另外，采用双皮瓣21例（38.2%），全部涉及同侧ALT皮瓣。 18 例患者在耳鼻喉科医生完成肿瘤切除之前成功完成双瓣抬高和预制。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

The free fibular flap has been elevated by a "lateral approach" from the posterior edge of the peroneal muscle for more than 40 years. However, in this approach, the surgical view is limited because flap elevation in mandibular reconstruction is performed simultaneously with tumor resection in the supine position, even when using positioning pillows. We herein propose an "anterior approach" as a new surgical method. We retrospectively investigated free fibular flap surgeries performed using the anterior approach, which consists of three anterior approaches, over a seven-year period. First, to avoid the course of the superficial peroneal nerve, the crural fascia was incised 1-2 cm posterior to the anterior edge of the peroneal muscle. The anterior edge of the peroneus muscle is detached from the anterior intermuscular septum. After performing osteotomies distal and proximal to the fibula, the interosseous membrane was incised from the anterior view. Pulling out the fibula to the anterior space between the anterior intermuscular septum and the peroneal muscle made the surgical field shallow. No postoperative superficial or deep peroneal nerve palsies were found in the 55 patients. Only one tourniquet was used in 31 of the 55 cases (56.4%), with an average of 95 min. Twenty-four patients (43.6%) required a second tourniquet 38 min after an interval. Only one tourniquet was used in 25 of the 30 (83.3%) cases in the last 3 years. Moreover, double flaps were used in 21 cases (38.2%), all of which involved ipsilateral ALT flaps. In 18 cases, double-flap elevation and prefabrication were successfully finished before the completion of tumor resection by otorhinolaryngologists.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.