University of Maribor School of Medicine, Plastic & Reconstructive Surgery, Maribor, Slovenia.
J Plast Reconstr Aesthet Surg. 2012 Nov;65(11):1530-6. doi: 10.1016/j.bjps.2012.04.045. Epub 2012 May 29.
The precise vascular anatomy of posterior lower leg skin is not well understood. Despite being a potential donor site for sural artery perforator flaps, this region is rarely used and underestimated. The aim of this study was to provide exact preoperative planning for medial and lateral sural artery perforator flap harvest.
An anatomical study on 16 cadaveric lower legs was performed to determine the number and location of all medial and lateral sural artery perforators in relation to five fixed points (medial and lateral maleolus, calcaneus, medial and lateral condyle). A Duplex study on 32 lower legs determined the number and location of dominant medial and lateral sural artery perforators in relation to same anatomical points. Results of the two studies were correlated.
A total of 234 perforators were found in the anatomical (134) and Duplex studies (100). A dominant lateral sural artery perforator was found in 9.4% of all lateral perforators in 31% of dissected legs. A dominant medial sural artery perforator was found in 37% of all medial perforators in 94% of legs. The difference in the number of dominant medial and lateral perforators was significant (p < 0.001) in the anatomical study, while no significant difference was found in the Duplex study (p = 0.920).
The anatomical study showed relative unreliability of sural region regarding number of dominant perforators. Therefore, harvest of medial and particularly lateral sural artery perforator flap is unsafe without preoperative perforator mapping. No significant difference in location of dominant perforators was found between Duplex and anatomical studies. Duplex proved reliable for planning of sural artery perforator flaps due to high precision in detecting location of dominant perforators.
人们对小腿后下部皮肤的精确血管解剖结构了解甚少。尽管该区域是比目鱼肌动脉穿支皮瓣的潜在供区，但由于该区域很少被使用和低估，故很少被用作皮瓣供区。本研究旨在为内侧和外侧比目鱼肌动脉穿支皮瓣的采集提供精确的术前规划。
对 16 具尸体小腿进行解剖学研究，以确定所有内侧和外侧比目鱼肌动脉穿支在五个固定点（内、外踝、跟骨、内、外髁）的数量和位置。32 条小腿的双功能超声研究确定了在相同解剖点与主导性内侧和外侧比目鱼肌动脉穿支的数量和位置。将两项研究的结果进行了相关性分析。
解剖学（134 个）和双功能超声研究（100 个）共发现 234 个穿支。在 31%的解剖小腿中，外侧比目鱼肌动脉穿支中有 9.4%为优势穿支；在 94%的小腿中，内侧比目鱼肌动脉穿支中有 37%为优势穿支。解剖学研究中，主导性内侧和外侧穿支数量的差异具有统计学意义（p < 0.001），而双功能超声研究中则无统计学意义（p = 0.920）。
解剖学研究表明，比目鱼肌区域的优势穿支数量相对不可靠。因此，在没有术前穿支定位的情况下，采集内侧和特别是外侧比目鱼肌动脉穿支皮瓣是不安全的。双功能超声和解剖学研究在优势穿支的位置上没有发现显著差异。双功能超声在检测优势穿支的位置方面具有较高的精度，因此对于比目鱼肌动脉穿支皮瓣的规划是可靠的。
