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Costal blood supply in free flap grafting.

The principal nourishment to the rib in a free flap is derived from the nutrient artery that pierces the costal head and terminates in the medullary cavity. A question surrounds the adequacy of the periosteal vessels in providing nourishment to the entire bone. A study of the blood supply and bony metabolism in the osseous portion of four free flaps of rib and attached pleura used to reconstruct the laryngotrachea in four dogs was undertaken. A microvascular anastomosis was attached to the anterior intercostal artery. An intact anastomosis was demonstrated in all four animals with fill of the most distal arborization in the bone in three. Technetium Tc 99m scanning, tetracycline labeling, and light microscopy revealed healthy metabolizing bone. The airway in all four animals was widely patent.