Purushothaman Rajendran, Balakrishnan T M, Alalasundaram K V
Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Indian J Plast Surg. 2013 Jan;46(1):69-74. doi: 10.4103/0970-0358.113713.
Peroneal artery gives off plenty of perforators that pass through fascial septum to supply skin and tenosynovium of peroneal muscles.
The aim of this study was to study the anatomical basis of perforators from terminal part of peroneal artery axiality and to make use of this knowledge in reconstructing defects of posterior heel with the advantage of reducing the morbidity of conventional flaps.
Our study was conducted at Department of Plastic surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, India. We have carried out eleven cadaver dissections (from six cadavers-four fresh cadavers and two preserved cadavers) and delineated all septocutaneous and septosynovial perforators of distal peroneal axis and studied their relation with short saphenous vein (SSV) and sural nerve. Using this anatomical knowledge we have fashioned perforator based flaps in 13 patients (three propeller, four V-Y advancement, six tenosynovial flaps) for reconstruction of defects over tendo achilles and pericalcaneal region.
In all cases, SSV and sural nerve were preserved and donor site was closed primarily. No total flap loss was noted.
Perforator based flaps from distal most part of peroneal artery provide a good and reliable method for reconstruction of pericalcaneal and tendo achilles region defects with preservation of SSV and sural nerve. It also avoids contour deformity of the grafted donor site of the classical lateral calcaneal artery axial flap.
腓动脉发出大量穿支，这些穿支穿过筋膜间隔，为腓骨肌的皮肤和腱鞘提供血液供应。
本研究旨在探讨腓动脉终末部穿支的解剖学基础，并利用这一知识重建足跟后部缺损，以减少传统皮瓣的并发症。
本研究在印度马德拉斯医学院和拉吉夫·甘地政府综合医院整形外科进行。我们进行了11例尸体解剖（来自6具尸体——4具新鲜尸体和2具防腐尸体），描绘了腓骨远端轴的所有隔皮和隔腱鞘穿支，并研究了它们与小隐静脉（SSV）和腓肠神经的关系。利用这一解剖学知识，我们为13例患者制作了穿支皮瓣（3例推进皮瓣、4例V-Y推进皮瓣、6例腱鞘皮瓣），用于修复跟腱和跟骨周围区域的缺损。
所有病例中，小隐静脉和腓肠神经均得以保留，供区一期缝合。未发现皮瓣完全坏死。
基于腓动脉最远端的穿支皮瓣为修复跟骨周围和跟腱区域缺损提供了一种良好且可靠的方法，可保留小隐静脉和腓肠神经。它还避免了经典的外侧跟骨动脉轴型皮瓣供区移植后的外形畸形。
