Top

Surgical and Radiologic Anatomy

Published in:

01-08-2018 | Original Article

Perforators of the fibular artery and suprafascial network

Authors: Julien Gaillard, Laurent-Marie Bourcheix, Alain-Charles Masquelet

Published in: Surgical and Radiologic Anatomy | Issue 8/2018

Abstract

Introduction

Soft tissue defect on lower limb can result in an intractable wound. Surgeons resort in flaps to cover these injuries. Including fascia as in the case of a fasciocutaneous flap increases survey of the flap. Rising a perforator flap avoids to sacrifice a major vessel whence the nourishing perforator artery is born. We wanted to explore suprafascial distribution of the fibular skin perforator arteries supposing possible to find out a vascular axis composed of anastomoses of the fibular perforator vessels.

Materials and methods

Systematic observation was carried out on ten injected legs about the fibular perforator distribution, and especially their suprafascial course.

Results

Dissection allowed us to raise in all specimens a large fasciocutaneous paddle including a fine arteriolar vessel connecting fibular perforators. Perforators were isolated along from the leg and we found suprafascial arteriole connecting all perforators from the fibular head to the lateral malleolus. There were a total number of 126 perforators for 10 legs. The mean length of the fibula was 32.9 cm. No perforator was located at more than 2 cm from fibular posterior border. Proximal perforators were closer to posterior fibular side than distal perforators. We found that fibular perforators clustered in the middle and upper third of the leg.

Conclusion

This study proves the real existence of a microvascular suprafascial axis formed by fibular perforator anastomoses and stretching over the entire length of the fibula, from the fibular head to the distal tip of the lateral malleolus. This suprafascial vascular axis could be an anatomical basis for a fasciocutaneous fibular flap.

Beppu M, Hanel DP, Johnston GH, Carmo JM, Tsai TM (1992) The osteocutaneous fibula flap: an anatomic study. J Reconstr Microsurg 8:215–223CrossRefPubMed

Boriani F, Bruschi S, Fraccalvieri M, Cipriani R (2010) Leg perforators and leg length: an anatomic study focusing on topography and angiogenesis. Clin Anat 23:593–605CrossRefPubMed

Carriquiry C, Aparecida Costa M, Vasconez LO (1985) An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 76:354–363CrossRefPubMed

Cormack GC, Lamberty BGH (1984) A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg 37:80–87CrossRefPubMed

Cormack GC, Lamberty BGH (1994) Alternative flap nomenclature and classification, the arterial anatomy of skin flaps, 2nd edn. Churchill Livingstone, Edinburgh, pp 514–522

Hallock GG (1999) Principles of fascia and fasciocutaneous flaps. In: Weinzweig J (ed) Plastic surgery secrets. Hanley and Belfus, Philadelphia, pp 419–426

Heitmann C, Khan FN, Levin LS (2003) Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 19:157–162CrossRefPubMed

Iorio ML, Cheerharan M, Olding M (2012) A systematic review and pooled analysis of peroneal artery perforators for fibula osteocutaneous and perforator flaps. Plast Reconstr Surg 130:600–607CrossRefPubMed

Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648CrossRefPubMed

10.

Kroll SS, Rosenfield L (1988) Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 81:561–566CrossRefPubMed

11.

Masquelet A-C, Romana M, Wolf G (1992) Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 89:1115–1121CrossRefPubMed

12.

Miyamoto S, Kayano S, Nagamatsu S, Sakuraba M (2012) Perforator anatomy of the fibula osteocutaneous flap. Plast Reconstr Surg 129:849–850CrossRef

13.

Niranjan NS, Price RD, Bovilkar P (2000) Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects. Br J Plast Surg 53:679–689CrossRefPubMed

14.

Ozalp T, Masquelet AC, Begue TC (2006) Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap. Surg Radiol Anat 28:54–58CrossRefPubMed

15.

Ponten B (1981) The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34:215–220CrossRefPubMed

16.

Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124:1529–1544CrossRefPubMed

17.

Saitoh S, Hata Y, Murakami N, Seki H, Kobayashi H, Shimizu T et al (2001) The “superficial” peroneal artery: a variation in cutaneous branching from the peroneal artery, nourishing the distal third of the leg. Br J Plast Surg 54:428–433CrossRefPubMed

18.

Salmon M (1936) Les Arteres de la peau. Masson, Paris

19.

Schaverien M, Saint-Cyr M (2008) Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 122:161–170CrossRefPubMed

20.

Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113–141CrossRefPubMed

21.

Taylor GI, Pan WR (1998) Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 102:599–618CrossRefPubMed

22.

Taylor GI, Corlett RJ, Dhar SC, Ashton MW (2011) The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg 127:1447–1459CrossRefPubMed

23.

Tolhurst DE, Haeseker B, Zeeman RJ (1983) The development of the fasciocutaneous flap and its clinical applications. Plast Reconstr Surg 71:597–606CrossRefPubMed

24.

Walton RL, Bunkis J (1984) The posterior calf fasciocutaneous free flap. Plast Reconstr Surg 74:76–85CrossRefPubMed

25.

Yoshimura M, Imura S, Shimamura K, Yamauchi S, Nomura S (1984) Peroneal flap for reconstruction in the extremity: preliminary report. Plast Reconstr Surg 74:402–409CrossRefPubMed

26.

Yu P, Chang EI, Hanasono MM (2011) Design of a reliable skin paddle for the fibula osteocutaneous flap: perforator anatomy revisited. Plast Reconstr Surg 128:440–446CrossRefPubMed

27.

Yoshimura M, Shimada T, Hosokawa M (2011) The vasculature of the peroneal tissue transfer. Plast Reconstr Surg 85:917–921CrossRef

Title: Perforators of the fibular artery and suprafascial network
Authors: Julien Gaillard
Laurent-Marie Bourcheix
Alain-Charles Masquelet
Publication date: 01-08-2018
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 8/2018
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-017-1927-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Perforators of the fibular artery and suprafascial network

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2018

The originating pattern of deep inferior epigastric artery: anatomical study and surgical considerations

A congenital accessory skin appendage of the nasal columella and nostril sill: a rare anatomical variation

Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review

Friar Leopold Mandic (1866–1942): the computed tomography of the body of a saint

Variations of right bronchial tree: a study with multi-detector CT

A rare case of atypical thoracodorsal artery: a challenge for flap reconstruction