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The Localization of the distal perforators of posterior tibial artery: a cadaveric study for the correct planning of medial adipofascial flaps

Bulla, Antonio and De Luca, L. and Campus, Gian Vittorio and Rubino, Corrado and Montella, Andrea Costantino Mario and Casoli, Vincent M. (2015) The Localization of the distal perforators of posterior tibial artery: a cadaveric study for the correct planning of medial adipofascial flaps. Surgical and Radiologic Anatomy, Vol. 37 (1), p. 19-25. ISSN 0930-1038. eISSN 1279-8517. Article.

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DOI: 10.1007/s00276-014-1275-9

Abstract

Purpose: 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.
Materials and methods: 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.
Results: 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 %.
Conclusion: 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.

Item Type:Article
ID Code:10302
Status:Published
Refereed:Yes
Uncontrolled Keywords:Perforator flaps, posterior tibial artery, adipofascial flap, lower leg injury, vascular injection
Subjects:Area 06 - Scienze mediche > MED/19 Chirurgia plastica
Area 05 - Scienze biologiche > BIO/16 Anatomia umana
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Chirurgiche, Microchirurgiche e Mediche
001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:Springer Paris
ISSN:0930-1038
eISSN:1279-8517
Deposited On:14 Nov 2014 13:25

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