Heitmann Christoph, Khan Fahar N, Levin L Scott
Department of Plastic, Reconstructive and Hand Surgery, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany.
J Reconstr Microsurg. 2003 Apr;19(3):157-62. doi: 10.1055/s-2003-39828.
Based on the dissection of 20 fresh cadaver legs, the authors have further defined the vascular anatomy of the peroneal artery and its cutaneous perforator vessels. They identified a total of 95 cutaneous perforators of the peroneal artery greater then 0.3 mm in 20 legs. The average number of cutaneous perforators was 4.8 (range: three to seven) per leg. The cutaneous perforators were either musculocutaneous (34 percent) or septocutaneous (66 percent). The musculocutaneous perforators were found predominantly in the upper two-thirds of the lower leg; the septocutaneous perforators were located in the lower two-thirds of the leg. The external diameter of the cutaneous perforators at the posterior border of the fibula was 0.6 (range: 0.3 to 1.5) mm. The blood supply of the proximal fibula epiphysis and fibula head was found not to be in the vascular territory of the peroneal artery. These results are the basis of the established osteoseptocutaneous fibula transfer, the peroneal fasciocutaneous free flap, and the double-paddle peroneal tissue transfer that all require dissection of highly vascularized tissue adjacent to the fibula, in order to reach the peroneal vessels. These constant anatomic findings should encourage the surgeon to harvest skin flaps just to the level of the posterior border of the fibula, thereby creating perforator flaps based on the peroneal system.
基于对20条新鲜尸体下肢的解剖，作者进一步明确了腓动脉及其皮穿支血管的血管解剖结构。他们在20条下肢中总共识别出95条直径大于0.3mm的腓动脉皮穿支。每条下肢皮穿支的平均数量为4.8条（范围：3至7条）。皮穿支要么是肌皮穿支（34%），要么是隔皮穿支（66%）。肌皮穿支主要位于小腿上三分之二；隔皮穿支位于小腿下三分之二。腓骨后缘处皮穿支的外径为0.6mm（范围：0.3至1.5mm）。发现腓骨近端骨骺和腓骨头的血供不在腓动脉的血管区域内。这些结果是已确立的骨隔皮腓骨转移、腓骨筋膜皮游离皮瓣和双叶腓骨组织转移的基础，所有这些手术都需要解剖腓骨附近高度血管化的组织，以显露腓血管。这些恒定的解剖学发现应促使外科医生将皮瓣切取至腓骨后缘水平，从而形成基于腓骨系统的穿支皮瓣。
