Rong Kai, Chen Chao, Hao Li-Wen, Xu Xiang-Yang, Wang Zeng-Tao
From the *Department of Orthopaedics, Shanghai Institute of Traumatology and Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine; and †Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
Ann Plast Surg. 2016 Sep;77(3):341-4. doi: 10.1097/SAP.0000000000000576.
The blood supply of the lateral supramalleolar flap (LSMF) generally comes from the perforating branch of the peroneal artery. However, the cutaneous branch may also receive blood from the anterior tibial artery. The main objective of the present study was to clarify the vascular anatomy of the LSMF.
Anatomical dissections were performed on 28 perfused fresh cadaver legs. The cutaneous branches of LSMF were identified, and the anatomic relationship between the cutaneous branches and the peroneal and anterior tibial arteries was analyzed.
The vascular supply for LSMF was divided into 2 main types. A collateral inferolateral branch from the anterior tibial artery anastomosed with the perforating branch of the peroneal artery around the inferior tibiofibular angle, and the main cutaneous branch of the flap arose from this arterial anastomosis in 20 of 28 limbs (71.4%). The collateral inferolateral branch was absent or very small in the other 8 of 28 dissections (28.6%), and the cutaneous branches solely arose from the perforating branch of the peroneal artery. The anastomosis of the descending branch of the peroneal artery and anterior lateral malleolar artery was always (100%) found around the tibiotalar joint.
In addition to the perforating branch of the peroneal artery, the LSMF may also receive blood from the anterior tibial artery through the collateral inferolateral branch. New modified proximally based flaps could be designed, and caution is warranted for these variations when a distally based flap is performed.
外踝上外侧皮瓣（LSMF）的血供一般来自腓动脉穿支。然而，皮支也可能接受来自胫前动脉的血液。本研究的主要目的是阐明LSMF的血管解剖结构。
对28条灌注新鲜尸体下肢进行解剖。识别LSMF的皮支，并分析皮支与腓动脉和胫前动脉之间的解剖关系。
LSMF的血管供应分为2种主要类型。胫前动脉的一条 collateral 下外侧支在胫腓下关节周围与腓动脉穿支吻合，皮瓣的主要皮支在28条肢体中的20条（71.4%）起源于该动脉吻合处。在28例解剖中的另外8例（28.6%）中，collateral 下外侧支缺失或非常小，皮支仅起源于腓动脉穿支。腓动脉降支与外踝前外侧动脉的吻合总是（100%）在距小腿关节周围发现。
除了腓动脉穿支外，LSMF还可能通过 collateral 下外侧支接受来自胫前动脉的血液。可以设计新的改良近端蒂皮瓣，在进行远端蒂皮瓣手术时，应注意这些变异情况。
