Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A
Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Okayama, Japan.
Plast Reconstr Surg. 1992 Oct;90(4):643-9. doi: 10.1097/00006534-199210000-00014.
Use of the posterior tibial flap pedicled on the posterior tibial vessels has been described by several authors, but with it there is the major disadvantage of an unavoidable transection of the posterior tibial artery. To overcome this disadvantage, we anatomically studied the perforators from the posterior tibial artery and used posterior tibial perforator-based flaps clinically. Based on our anatomic study of 25 cadaveric legs, the cutaneous perforators were considered to be distributed from the distal to the proximal sides of the lower leg through the medial border of the tibia, and they were classified into three types: septocutaneous perforators mainly located in the distal third of the leg, muscle perforators located in the proximal half, and periosteal perforators in the proximal third of the leg. The average size and number of perforators was 0.8 mm and 3.1 in one leg, respectively. A considerable number were located at sites from 70 to 140 mm superior to the medial malleolus. Based on our clinical cases repaired with flaps, we consider this flap to be useful as a free flap for the repair of defects of the extremities and as an island flap for reconstruction of defects on the anteromedial aspect of the lower leg. The territory of the flap is relatively wide, being 19 x 13 cm. The long saphenous vein can be used safely as the venous drainage system in the case of free-flap transfer.
多位作者描述了以胫后血管为蒂的胫后皮瓣的应用，但使用该皮瓣存在一个主要缺点，即不可避免地要横断胫后动脉。为克服这一缺点，我们对胫后动脉的穿支进行了解剖学研究，并在临床上应用了以胫后穿支为基础的皮瓣。基于对25条尸体下肢的解剖学研究，皮肤穿支被认为是从胫骨内侧缘自小腿远端向近端分布，可分为三种类型：主要位于小腿远端三分之一的肌间隔皮穿支、位于近端一半的肌皮穿支以及位于小腿近端三分之一的骨膜穿支。每条下肢穿支的平均大小和数量分别为0.8毫米和3.1个。相当数量的穿支位于内踝上方70至140毫米处。基于我们用皮瓣修复的临床病例，我们认为该皮瓣作为游离皮瓣用于修复肢体缺损以及作为岛状皮瓣用于修复小腿前内侧缺损很有用。皮瓣的面积相对较宽，为19×13厘米。在游离皮瓣转移的情况下，大隐静脉可安全地用作静脉引流系统。
