Stevanović Goran, Djordjević Boban, Daković Marija, Trenkić Srbobran, Stojiljković Danilo, Jeremić Slavica, Paravina Jadranka, Janković Irena, Golubović Zoran, Smiljković Igor
Klinicki centar Nis, Klinika za plasticnu i rekonstruktivnu hirurgiju, Nis, Srbija.
Vojnosanit Pregl. 2010 Feb;67(2):136-44. doi: 10.2298/vsp1002136s.
BACKGROUND/AIM: Soft tissue defects of the lower leg, especially in its distal third, still remain a challenging problem in reconstructive surgery. The aim of this study was to examine septocutaneous system of lower leg vascularization, quantitatively and qualitatively, which is the basis of fasciocutaneous and neurocutaneous flaps.
Septocutaneous systems a. tibialis posterior and a. peroneae were examined by anatomical suprafascial lower leg microdissection of 40 fresh cadavers. Septocutaneous perforators located intermusculary, in deep crural fascia duplicature, were followed from its origin (at main arterial trunks of the lower leg) till the point they reach the deep crural fascia. The number and localization of emergence of the septocutaneous perforators were examined for both above mentioned arterial trunks, and the obtained data were documented by photographs, tables and graphics. Statistical analysis (especially cluster analysis), was used for establishing reliable septocutaneous perforators levels.
Septocutaneous perforator systems of the lower leg have constant and reliable pattern of existance. Lower leg length was 36 cm in average, (between 33 and 43 cm). Lower leg was divided in 10 equal segments, 3.6 cm each. A. tibialis posterior and a. peronea had 5 septocutaneous perforators. Cluster analysis of a. tibialis posterior perforators (with diameter > or = 0.5 mm), discovered 5 reliable levels of septocutaneous perforators. These levels are at 3.6-10.8 cm; 14.4--21.6 cm and 25.2-28.8 cm. For a. peronea reliable perforators were found at 3.6-10.8 cm, 14.4--18 cm and 21.6-25.2 cm. Posterior tibial artery perforators had the greatest diameter (from 0.5-1.8 mm; mean value 1.14 mm and SD = 0.26 mm). A mean diameter for peroneal artery perforators was 0.9 mm. Conclusion. Existance of reliable levels of septocutaneous perforators of the lower leg enables and makes reconstruction of the soft tissue defects of the lower leg, especially its distal third and foot, much easier.
背景/目的：小腿软组织缺损，尤其是小腿远侧1/3段的缺损，在重建外科中仍然是一个具有挑战性的问题。本研究的目的是对小腿血管化的穿隔皮系统进行定量和定性研究，该系统是筋膜皮瓣和神经皮瓣的基础。
通过对40具新鲜尸体进行小腿筋膜上显微解剖，研究胫后动脉和腓动脉的穿隔皮系统。追踪位于肌间、小腿深筋膜双层内的穿隔皮穿支，从其起源（在小腿主要动脉干处）直至到达小腿深筋膜的点。检查上述两条动脉干穿隔皮穿支的出现数量和位置，并通过照片、表格和图表记录所获得的数据。采用统计分析（尤其是聚类分析）来确定可靠的穿隔皮穿支水平。
小腿穿隔皮穿支系统具有恒定且可靠的存在模式。小腿平均长度为36 cm（范围在33至43 cm之间）。将小腿分为10个相等的节段，每段3.6 cm。胫后动脉和腓动脉各有5个穿隔皮穿支。对胫后动脉穿支（直径≥0.5 mm）进行聚类分析，发现了5个可靠的穿隔皮穿支水平。这些水平分别在3.6 - 10.8 cm；14.4 - 21.6 cm和25.2 - 28.8 cm处。对于腓动脉，在3.6 - 10.8 cm、14.4 - 18 cm和21.6 - 25.2 cm处发现了可靠的穿支。胫后动脉穿支直径最大（0.5 - 1.8 mm；平均值1.14 mm，标准差 = 0.26 mm）。腓动脉穿支的平均直径为0.9 mm。结论。小腿穿隔皮穿支可靠水平的存在使得小腿软组织缺损，尤其是其远侧1/3段和足部的重建变得更加容易。
