| Objective:To study the arterial relation of anterior tibial artery and peroneal artery in the lower part of leg, and to determine the main patterns of origin of the lateral supramalleolar cutaneous branches, provide anatomic basis for new clinical applications of repair in this area.Methods:30fresh cadaver legs injected with red latex were dissected, and8patients receiving repair of the lateral supramalleolar flap were measured. The data such as the outer diameter and length of related vessels were measured by vernier caliper, and handled by spss13.0analysis system.Results:1.23out of30cadaver legs (76.7%) were found that there is an arterial arch between the anterior tibial artery and the peroneal artery, which is proximal to the inferior tibiofibular syndesmosis. Complete arterial arch is not found in the other7cadaver legs (23.3%).2. There are two accompanying veins (0.4mm～2.9mm) besides the arterial arch, which have the similar course as the arch.3. There are several branches arising from the arterial arch between the anterior tibial artery and the peroneal artery, such as branches supplying nearby skin, muscles and periosteum.4. The outer diameter of the arterial arch arising from the anterior tibial artery is (1.4±0.3) mm, apart from lateral malleolus (6.2±0.6) cm; the outer diameter of arterial arch penetrating from the interosseous membrane is (1.3±0.3) mm, apart from lateral malleolus (5.6±0.5) cm; and the length of the arterial arch between the two points is (4.3±0.5) cm.5.22out of23cadaver legs with complete arterial arch are found that the lateral supramalleolar cutaneous branches arise from the arterial arch:9legs (30.0%) have the common origin of the cutaneous branch and the descending branch,13legs (43.3%) cutaneous branch and the descending branch arise from different parts of the arch. And one leg with complete arch is found that the cutaneous branch and the descending branch arise from different parts of peroneal artery. In the orther7legs without complete arterial arch, the cutaneous branch and the descending branch arise from the perforating branch of peroneal artery.6. The outer diameter of common origin is(1.1±0.2) mm, arterial arch on the tibial side is (1.3±0.3) mm, arterial arch on the fibular side is (1.3±0.3) mm. The outer diameter of the origination of the cutaneous branch and the descending branch is (0.7±0.2) mm and (0.8±0.2) mm.7.5out of8patients receiving flap repair are found with complete arterial arch, from which the cutaneous branch and the descending branch arise; there is no complete arterial arch in the other3patients, and the cutaneous branch and descending branch arise from the perforating branch of peroneal artery.Conclusion:1. There is an arterial arch between the anterior tibial artery and the peroneal artery, which is proximal to the inferior tibiofibular syndesmosis, apart from the lateral malleolus tip5cm. The existence ratio is76.7%. The characters of the arch are:①like an arch, convex to the downward;②pass through the interosseous membrane between the tibia and fibula;③has two accompanying veins;④several branches of skin, muscles and periosteum arising from the arch.2. This arterial arch communicates the anterior tibial artery and the peroneal artery in the lower part of the leg. making the branches of skin, muscles and periosteum have potential double-way blood supply.3. According to existence of the arterial arch, the origin of cutaneous branch and the outer diameter of related vessels, There are two main patterns of origin of the cutaneous branch:Type I:arterial arch type (22,73.3%), the cutaneous branch or the common origin of the cutaneous branch and the descending branch arise from the arterial arch between the anterior tibial artery and the peroneal artery.(1) According to the location of the cutaneous branch and the descending branch, there are three subtypes:①he cutaneous branch and the descending branch have a common origin from the arterial arch②The cutaneous branch and the descending branch arise from the arterial arch separately, and the cutaneous branch is on the fibular side③The cutaneous branch and the descending branch arise from the arterial arch separately, and the cutaneous branch is on the tibial side(2) According to the outer diameter the cutaneous branch, and the arterial arch on both sides, there are also three subtypes:①Equal type:3/4<ratio of the outer diameter of the arterial arch on tibial side and fibular side<4/3;②Peroneal artery dominant type:ratio of the outer diameter of the arterial arch on tibial side and fibular side≤3/4;③Anterior tibial artery dominant type:ratio of the outer diameter of the arterial arch on tibial side and fibular side≥4/3Type Ⅱ:peroneal artery type (26.7%), the arterial arch is not complete, and the cutaneous branch arises from the perforating branch of the peroneal artery; or the cutaneous branch arise from the peroneal artery directly.4. The types of origin of the cutaneous branch has important clinical significance.(1) New transfer lateral supramalleolar flap can be designed:①pedicled by the arch on the tibial side of cutaneous branch;②pedicled by the tibial artery proximal to the arch;③pedicled by the tibial artery distal to the arch.(2) New free lateral supramalleolar flap can also be design:①pedicled by the arch on the tibial side or the fibular side of cutaneous branch;②pedicled by the anterior tibial artery or the peroneal artery on both sides of the arch, to repair the shin defect with artery trunk defect.(3) To design combined flap of lateral supramalleolar flap and the other anterior tibial artery-pedicled flaps, such as dorsalis pedis flap.(4) When repair defect with the lateral supramalleolar flap pedicled by the descending branch, The relationship between cutaneous branch and the descending branch should be identified before cutting off the vessels.5. Preoperative arteriography and careful anatomy during operation can identify the existence of arterial arch between the anterior tibial artery and the peroneal artery proximal to the inferior tibiofibular syndesmosis, and the type of cutaneous branch of lateral supramalleolar flap. |
PDF Full Text Request