Department of Plastic and Reconstructive Surgery, KAT General Hospital, Athens, Greece.
J Plast Reconstr Aesthet Surg. 2009 Nov;62(11):1524-9. doi: 10.1016/j.bjps.2008.06.013. Epub 2008 Aug 13.
Traumatic or trophic defects of the soft tissue of the lower leg are quite often very difficult to manage, especially in the distal third of the leg. Fasciocutaneous flaps are a relatively simple option for covering small- and medium-sized defects of the lower leg. The aim of this study is to investigate the distribution of septocutaneous perforators of the anterior tibial artery and their possible clinical applications.
An anatomical study was performed on 50 fresh adult cadaveric lower extremities. Using coloured contrast materials, the location of septocutaneous perforators, originating from the anterior tibial artery, were mapped. These findings were then compared with colour Doppler imaging (CDI) data in 20 living volunteers.
The septocutaneous perforators of the anterior tibial artery follow a reproducible pattern all over the lower leg (septa I, II and III). In the distal segment, we found relatively few perforators. There was a marginal difference between cadaveric and CDI data for perforators with diameter >or=1mm. The average number of anterior tibial artery septocutaneous perforators in anatomical dissections was 6.6+/-2.4, while CDI revealed 8.2+/-3.2 perforators in living volunteers (P=0.053). In five areas of the lower leg, there is a >50% chance that a septocutaneous perforator with diameter >or=1mm is coming off the anterior tibial artery. Anatomical dissections for a cutaneous territory 5 cm above the lateral maleollus, and 10 cm in width, revealed 6.1+/-2.2 septocutaneous perforators (range 4 to 12).
CDI, paired with knowledge of anatomical details, is a reliable tool for preoperative identification of septocutaneous perforators of 1mm or larger outer diameter, thus providing critical information for planning and harvesting safe fasciocutaneous flaps of the lower leg. Additionally, according to our anatomical study, a new transverse fasciocutaneous flap (Type B according to the Nahai-Mathes classification), located over the distal anterolateral third of the lower leg and based on perforators of the anterior tibial artery, may be successfully used for covering selected defects of the distal third of the lower leg.
小腿软组织的创伤性或营养性缺损通常非常难以处理，尤其是在小腿的远端三分之一处。筋膜皮瓣是覆盖小腿中小面积缺损的相对简单的选择。本研究旨在探讨胫前动脉穿支的分布及其可能的临床应用。
对 50 例新鲜成人尸体下肢进行解剖学研究。使用彩色对比材料，绘制起源于胫前动脉的穿支的位置。然后将这些发现与 20 名活体志愿者的彩色多普勒成像（CDI）数据进行比较。
胫前动脉的穿支在小腿的各个部位都呈现出可重复的模式（I、II 和 III 隔）。在远端节段，我们发现相对较少的穿支。对于直径≥1mm 的穿支，尸体解剖数据与 CDI 数据之间存在微小差异。解剖学剖检中胫前动脉穿支的平均数量为 6.6+/-2.4，而 CDI 显示活体志愿者中有 8.2+/-3.2 个穿支（P=0.053）。在小腿的五个区域，有超过 50%的可能性有直径≥1mm 的穿支从胫前动脉发出。对外侧外踝上方 5cm 宽 10cm 的皮肤区域进行解剖，发现 6.1+/-2.2 个穿支（范围 4 到 12）。
CDI 结合解剖学细节知识是术前识别直径 1mm 或更大的穿支的可靠工具，从而为规划和采集安全的小腿筋膜皮瓣提供关键信息。此外，根据我们的解剖学研究，一种新的横形筋膜皮瓣（根据 Nahai-Mathes 分类为 B 型），位于小腿远端前外侧三分之一处，以胫前动脉的穿支为基础，可能成功用于覆盖小腿远端三分之一的选定缺损。
