Bulla A, De Luca L, Campus G V, Rubino C, Montella A, Casoli V
Plastic Surgery Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Via Pasubio 5, 07100, Sassari, Italy,
Surg Radiol Anat. 2015 Jan;37(1):19-25. doi: 10.1007/s00276-014-1275-9. Epub 2014 Mar 5.
The adipofascial flap, introduced by Lin in 1994, has many advantages compared to fasciocutaneous or free flaps. Its dissection is relatively easy and fast with low donor-site morbidity, and it does not alter the shape of the leg. The aim of this dissection study is to evaluate the anatomic localization of the most distal perforator of the posterior tibial vessels to provide an anatomical rationale for the safe harvesting of distally based medial adipofascial flaps of the leg.
30 Lower limbs from 15 cadavers were used for this study. The most distal perforator from posterior tibial perforator artery, accompanied by at least one vein, was identified and its distance from the medial malleolus was noted.
A distal perforator was found in all specimens; the mean caliber was 0.77 mm. In all cases, the perforator artery passed in the septum between flexor hallucis longus m. and flexor digitorum longus m. and was accompanied by two veins. In our series, the distance between the lowest perforator and the medial malleolus ranged from 3.5 to 8.2 cm. The median was 6.75 cm, the 5th percentile 4 cm and the 95th percentile 8.1 cm. The mean distance of the perforator from the medial tibial border was 1.23 cm. The mean ratio between the distance of perforator from the medial malleolus and the total leg length was 21%.
Compared to all previous researches, our study has found more distal perforators from posterior tibial perforator artery. This fact may have important clinical consequences, because the anteromedial adipofascial flap would cover more distal soft tissue defects. Moreover, our data suggest some safety parameters to make the rising of a medial adipofascial leg flap safer in surgical practice.
林在1994年提出的脂肪筋膜瓣与筋膜皮瓣或游离皮瓣相比有许多优点。其解剖相对容易且快速，供区发病率低，并且不会改变腿部形状。本解剖学研究的目的是评估胫后血管最远端穿支的解剖定位，为安全切取小腿远端蒂内侧脂肪筋膜瓣提供解剖学依据。
本研究使用了来自15具尸体的30条下肢。确定胫后穿支动脉最远端的穿支，其至少伴有一条静脉，并记录其与内踝的距离。
在所有标本中均发现了远端穿支；平均管径为0.77毫米。在所有病例中，穿支动脉走行于拇长屈肌和趾长屈肌之间的肌间隔内，并伴有两条静脉。在我们的研究系列中，最低穿支与内踝之间的距离为3.5至8.2厘米。中位数为6.75厘米，第5百分位数为4厘米，第95百分位数为8.1厘米。穿支与胫骨内侧缘的平均距离为1.23厘米。穿支与内踝的距离与小腿总长度的平均比值为21%。
与以往所有研究相比，我们的研究发现了更多来自胫后穿支动脉的远端穿支。这一事实可能具有重要的临床意义，因为小腿前内侧脂肪筋膜瓣可以覆盖更多远端的软组织缺损。此外，我们的数据提示了一些安全参数，以使手术中切取小腿内侧脂肪筋膜瓣更加安全。
