Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
J Plast Reconstr Aesthet Surg. 2023 Aug;83:165-171. doi: 10.1016/j.bjps.2023.04.074. Epub 2023 Apr 25.
The medial gastrocnemius (GN) muscle flap is a historical reconstructive option in lower limb reconstruction. The flap is proximally based on the medial sural artery, and it is assumed not possible to harvest a distally based flap because of the absence of other minor pedicles. The aim of this study is to investigate the presence and the anatomy of a distal secondary pedicle given off by the posterior tibial artery (PTA).
A retrospective CTA study was performed of 120 limbs between April 2018 and June 2020. 3D reconstruction was performed to delineate the anatomy of the distal secondary pedicle, if present. The distance of the pedicle, if found, from the intermalleolar line to the patella was noted. The number of pedicles, if multiple, was documented, as well as branches to the soleus muscle and the skin.
A distal pedicle to the gastrocnemius muscle was found in 64% of limbs. The average location from the intermalleolar line is 168 mm. The branching pattern from the PTA showed an isolated vessel going to the distal medial gastrocnemius (32.8%), two branches to the medial gastrocnemius and skin (39.3%), two branches to the medial gastrocnemius and soleus (24.6%), and three branches to the medial gastrocnemius, soleus, and the skin (3.3%).
This study confirms the presence of the secondary axial distal pedicle of the GN muscle. Furthermore, this study confirms that there is a likely association between the distal medial gastrocnemius pedicle and the PTA skin perforators.
内侧腓肠肌（GN）肌皮瓣是下肢重建的一种历史重建选择。皮瓣以腓肠内侧动脉为近端基础，由于没有其他小蒂，因此假设不可能采集远端基础皮瓣。本研究旨在探讨是否存在并解剖出由胫后动脉（PTA）发出的远端次级蒂。
对 2018 年 4 月至 2020 年 6 月间的 120 条肢体进行了回顾性 CTA 研究。如果存在，进行 3D 重建以描绘出远端次级蒂的解剖结构。如果存在，记录蒂的位置（从内踝间线到髌骨）。如果存在多个蒂，则记录蒂的数量以及与比目鱼肌和皮肤的分支。
在 64%的肢体中发现了腓肠肌的远端蒂。从内踝间线的平均位置为 168mm。从 PTA 发出的分支模式显示出一种孤立的血管通向远端内侧腓肠肌（32.8%），两条分支通向内侧腓肠肌和皮肤（39.3%），两条分支通向内侧腓肠肌和比目鱼肌（24.6%），以及三条分支通向内侧腓肠肌、比目鱼肌和皮肤（3.3%）。
本研究证实了 GN 肌的次级轴远端蒂的存在。此外，本研究还证实了远端内侧腓肠肌蒂与 PTA 皮肤穿支之间存在关联的可能性。
