A reappraisal of axial and nonaxial lower leg fascial flaps: an anatomic study in human cadavers.

The aim of this study was to determine the sources of blood supply to the deep fascia of the lower leg and therefore to identify potential new sites where axial and nonaxial flaps might be raised. The deep fascia was harvested from 18 embalmed cadaver lower legs. The blood supply to the deep fascia was examined with the aid of a dissecting microscope. Four clinically important sources of supply to the deep fascia were identified. These were (1) axial and nonaxial fasciocutaneous perforators, (2) nonaxial musculocutaneous perforators, (3) axial cutaneous branches of the sural arteries, and (4) an axial fascial branch from the saphenous artery (present in 75 percent of the dissections). This study has highlighted the potential for utilizing not only the fasciocutaneous system and sural system of vessels but also the fascial branch of the saphenous artery in the design of lower leg axial fascial flaps. Nonaxial fascial island flaps may be raised utilizing not only the fasciocutaneous system of vessels but also the musculocutaneous system of vessels.