| Objective:To study the anatomic structure of popliteal cutaneous artery, and to provide anatomic basis for clinical applications of flaps with pedicle of popliteal cutaneous artery, which is benefit for the design and elevation of posterior proximal flaps of leg.Methods:23fresh cadaver legs injected with red latex were dissected.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. All of23cadaver legs were found that there are2popliteal cutaneous arteries, which accompany with medial and lateral sural cutaneous nerves repectively. The medial popliteal cutaneous artery, which lie in the middle of popliteal fossa, accompany with medial sural cutaneous nerve beneath deep fascia and accompany with small saphenous vein after going out of deep fascia to nourish skin. Lateral popliteal cutaneous artery penetrates deep fascia at the junction of medial border of peroneus longus, medial border of biceps femoris and laterl border of gastrocnemious, and descends accompany with lateral sural cutaneous nerve to nourish skin on lateral head of gastrocnemious. 2.8of all the23limbs were found that two cutaneous arteries ascend from popliteal artery distinguishly. Two cutaneous arteries arise from a common sural artery was found in2limbs.5limbs were found that medial and lateral cutaneous arteries arise from medial and lateral sural arteres distinguishly, and both cutaneous arteries arise from a common trunk from medial sural artery in1limb and from lateral sural artery in2limb. Lateral cutaneous artery ascends from popliteal artery and medial cutaneous artery ascends from medial sural artery was found in one limb.3. Lateral popliteal cutaneous artery was found in all23the limbs,22(95.65%) of which anastomosed with perforating branch of femoral artery, which forms an artery chain. Lateral popliteal cutaneous artery is12.90±4.43cm in length and1.34±0.21mm in diameter.1limb was found the lateral popliteal cutaneous artery was thin and short, the length of which was4.07cm and diameter was0.51mm. For compensation, a musculocutaneous perforating artery with diameter of1.84mm arised from lateral sural artery anastomosed with fibular artery. Many small branches arising from lateral popliteal cutaneous artery anastomosed with that from medial popliteal cutaneous artery during they travelling downwards to form a vessel network.1limb was found a branch with length of4.02cm and width of1.01mm arised from lateral popliteal cutaneous artery travelled to the central of popliteal fossa and accompanied with small saphenous vein.4. Medial popliteal cutaneous artery was found in all the23limbs. Medial popliteal cutaneous artery accompanied with medial sural cutaneous nerve before piercing deep fascia and after that the artery accompanied with small saphenous vein, and formed vessel chain with posterior tibial artery. The transverse branches arising from medial popliteal cutaneous artery anastomosed with transverse branches arising from saphenous artery and lateral popliteal cutaneous artery to form vessel network. The length and diameter of medial popliteal cutaneous artery is8.02±3.02cm and1.45±0.21mm respectively.1limb was found that after arising from popliteal artery medial popliteal cutaneous artery divided into two branches, one of which accompanied with medial sural cutaneous nerve under deep fascia with length of9.61cm and diameter of1.21mm, the other branch however accompanied with small saphenous vein in superficial fascia with length of7.23cm and diameter of1.72mm.Conclusion:1. The number of popliteal cutaneous arteries is not3as described before, there are2popliteal cutaneous arteries, which accompany with medial and lateral sural cutaneous nerves respectively. The characters of popliteal cutaneous arteries are:①Popliteal cutaneous arteries accompany with medial and lateral sural cutaneous nerves respectively, and travel downwards to distal part of posterior of leg.②Many small branches arising from lateral popliteal cutaneous artery anastomosed with that from medial popliteal cutaneous artery during they travelling downwards to form a vessel network.③Lateral popliteal cutaneous artery is accompanied with homonymic superficial vein, and medial popliteal cutaneous artery is accompanied with homonymic superficial vein and small saphenous vein.④Popliteal cutaneous artery pierces deep fascia to nourish skin.⑤Lateral popliteal cutaneous artery anastomoses with perforating branch from fibular artery to form vessel chain, and medial popliteal cutaneous artery anastomoses with perforating branch from posterior tibial artery to form vessel chain2. Popliteal cutaneous artery can be classified in4types according to the arisen of which. We regard common sural artery, medial sural artery and lateral sural artery as sural artery; Lateral and medial popliteal arteries arising from a common trunk or arising from a same artery is regarded as a same type. Type I popliteal artery type:Both two cutaneous arteries arise from popliteal artery, and there are11limbs in this type (47.82%), of which4limbs have a same arisen trunk. Type II sural artery type:Both two cutaneous arteries arise from sural artery, and there are10limbs in this type (43.48%), of which3limbs have a same arisen trunk, and1trunk arises from medial sural artery, the other2trunks arise from lateral sural artery. Type III:hybrid, two skins from sural artery and popliteal artery type, mixed type and there are two subtypes. Type Ⅲa llimb was found that lateral popliteal cutaneous artery arose from popliteal artery and medial popliteal cutaneous artery arose from sural artery (4.35%); Type Ⅲb llimb was found that lateral popliteal cutaneous artery arose from sural artery and medial popliteal cutaneous artery arose from popliteal artery (4.35%).3. Lateral popliteal cutaneous artery anastomoses with perforating branch from fibular artery to form vessel chain, and medial popliteal cutaneous artery anastomoses with perforating branch from posterior tibial artery to form vessel chain. There are plentiful vessel networks between two vessel chains, which supply sufficient blood to posterior of leg. Posterior flap of leg can be designed with pedicle of either medial popliteal cutaneous artery or lateral popliteal cutaneous artery:the flap can be antegrade with pedicle of the arising part of medial or lateral popliteal cutaneous artery, or retrograde with pedicle of vessel chain composed of medial popliteal cutaneous artery and perforating branch from posterior tibial artery or vessel chain composed of lateral popliteal cutaneous artery and perforating branch from fibular artery.4. Body surface location of popliteal cutaneous artery:the arisen point of medial popliteal cutaneous artery is at about the middle point of popliteal fossa, and accompanied with medial sural cutaneous nerve before piercing deep fascia and after that the artery accompanied with small saphenous vein, and formed vessel chain with posterior tibial artery. Lateral popliteal cutaneous artery penetrates deep fascia at the junction of medial border of peroneus longus, medial border of biceps femoris and laterl border of gastrocnemious, and descends accompany with lateral sural cutaneous nerve to nourish skin on lateral head of gastrocnemious. Doppler is needed for precise location. |
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