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Volume 39 Issue 12
Dec.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(12): 1163-1167
Zhao FJ,Zhu L,Yao XX,et al.Anatomical study of the architecture of the cutaneous branch-chained blood vessels in the medial lower leg in adult[J].Chin J Burns Wounds,2023,39(12):1163-1167.DOI: 10.3760/cma.j.cn501225-20231102-00174.
Citation: Zhao FJ,Zhu L,Yao XX,et al.Anatomical study of the architecture of the cutaneous branch-chained blood vessels in the medial lower leg in adult[J].Chin J Burns Wounds,2023,39(12):1163-1167.DOI: 10.3760/cma.j.cn501225-20231102-00174.
shu

Anatomical study of the architecture of the cutaneous branch-chained blood vessels in the medial lower leg in adult

doi: 10.3760/cma.j.cn501225-20231102-00174
  • 1.

    Department of Hand Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou 310014, China

  • 2.

    Hangzhou Normal University School of Basic Medical Sciences, Hangzhou 311121, China

Funds:

Medical Health Science and Technology Project of Zhejiang Province of China 2022480357

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    Abstract
  •   Objective   To investigate the architecture of the cutaneous branch-chained blood vessels in the medial lower leg and provide the anatomical basis for design and clinical application of the cutaneous branch-chained flap from this region.   Methods   The experimental research method was used. From March to May 2023, the anatomical study was conducted on the 5 voluntarily donated fresh adult (aged 50 to 70 years, all male) cadaveric specimens from Hangzhou Normal University School of Basic Medical Sciences. The fine anatomy under microscope was performed on each lower leg specimens of 5 corpses (1 lower leg specimen was conducted with digital radiography (DR) scan before fine anatomy), to observe, measure, and record the course of posterior tibial artery, quantity of perforator, the distance between the perforating point of each perforator and the medial condyle of tibia, the external diameter of posterior tibial artery perforator, the length of perforator pedicle, the horizontal distance between the posterior tibial artery perforator and the saphenous nerve, and the course of each perforator within superficial fascia after crossing the deep fascia and the distribution of the cutaneous branch-chains. The DR scan under the perfusion of barium sulfate was conducted in one lower leg specimen to observe the distribution of cutaneous branch-chained vascular network (hereinafter referred to as vascular chain) between perforators. Transparent skin specimen was made from one leg specimen after anatomy to observe the distribution of perforators and vascular chains between perforators.   Results   In 5 lower leg specimens, the upper part of posterior tibial artery was located deep in soleus muscle, and the lower part was located between the medial edge of gastrocnemius muscle and flexor digitorum longus muscle. A total of 28 posterior tibial artery perforators were identified, with an average of 5.6 branches in each lower leg. The distance between the perforating point of perforator and the medial condyle of tibia ranged from 6.5 to 36.0 cm, mainly distributed at 22.0 (15.1, 28.1) cm from the medial condyle of tibia, in zones 3 to 6. The external diameters of perforators of posterior tibial arteries were 0.7-1.1 mm. The length of perforator pedicle was 1.0-4.5 cm, and the horizontal distance between the posterior tibial artery perforator and the saphenous nerve was 0.5-3.0 cm. The fine anatomy under microscope showed that the posterior tibial artery perforators had long upward and downward branches after crossing the deep fascia, and the ascending branches and descending branches were anastomosed longitudinally to form the nutrient cutaneous branch-chain in the medial lower leg. DR scan and transparent skin specimen both showed that longitudinal vascular chain was formed between the posterior tibial artery perforators, the transparent skin specimen also showed that longitudinal blood vessel chains included the direct connecting vessels in the adipose layer and the indirect connecting vessels in the subdermal layer.   Conclusions   The cutaneous branch-chained vessels in the medial lower leg are constructed by posterior tibial artery perforators, direct connecting vessels, indirect connecting vessels, and traffic branches. The cutaneous branch-chained flap is reliable in terms of vascular anatomy, and can carry the saphenous nerve for partial restoration of its sensation, thus it is an ideal flap.

     

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    • References(14)
  • [1]
    汪坤菊,石小田,丁自海,等.腓动脉皮支链皮瓣的应用解剖[J].解剖学杂志,2020,43(4):309-312.DOI: 10.3969/j.issn.1001-1633.2020.04.008.
    [2]
    秦向征,李良昌,李光昭,等.小腿后外侧穿支皮支链的解剖学研究[J].中国临床解剖学杂志,2015,33(2):138-140.DOI: 10.13418/j.issn.1001-165x.2015.02.005.
    [3]
    AyyappanT,ChadhaA.Super sural neurofasciocutaneous flaps in acute traumatic heel reconstructions[J].Plast Reconstr Surg,2002,109(7):2307-2313.DOI: 10.1097/00006534-200206000-00022.
    [4]
    张永宏,沈国良,赵小瑜,等.邻近筋膜皮瓣修复胫前区骨或钢板外露小创面的临床效果[J].中华烧伤杂志,2018,34(12):907-909.DOI: 10.3760/cma.j.issn.1009-2587.2018.12.016.
    [5]
    许良,王楠,王利祥.胫后动脉穿支联合隐神经营养血管筋膜蒂皮瓣修复足底内侧创面[J].中华显微外科杂志,2020,43(1):10-14.DOI: 10.3760/cma.j.issn.1001-2036.2020.01.004.
    [6]
    巨积辉,周荣,刘跃飞,等.超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果[J].中华烧伤杂志,2019,35(7):495-500.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.004.
    [7]
    何晓清,杨曦,石岩,等.腓肠外侧浅动脉穿支皮瓣术中解剖学观察及临床意义[J].中国临床解剖学杂志,2023,41(2):132-136.DOI: 10.13418/j.issn.1001-165x.2023.2.03.
    [8]
    丁自海,王增涛,钟世镇.皮瓣解剖学研究的三个阶段[J].中华显微外科杂志,2010,33(3):180-181.DOI: 10.3760/cma.j.issn.1001-2036.2010.03.002.
    [9]
    张国雷,李文庆,朱小弟,等.手指筋膜蒂指掌侧固有动脉皮支链皮瓣修复指端软组织缺损13例[J].中华显微外科杂志,2019,42(3):275-276.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.016.
    [10]
    王辉,杨晓溪,霍永鑫,等.尺动脉穿支血管链皮瓣修复吻合血管的前臂远端或腕部创面的临床效果[J].中华烧伤杂志,2021,37(7):635-639.DOI: 10.3760/cma.j.cn501120-20200422-00234.
    [11]
    MehrotraS.Perforator-plus flaps: a new concept in traditional flap design[J].Plast Reconstr Surg,2007,119(2):590-598.DOI: 10.1097/01.prs.0000239570.18647.83.
    [12]
    DrimourasG, KostopoulosE, AgiannidisC,et al. Redefining vascular anatomy of posterior tibial artery perforators: a cadaveric study and review of the literature[J].Ann Plast Surg,2016,76(6):705-712. DOI: 10.1097/SAP.0000000000000258.
    [13]
    JakubietzRG,NickelA,NeshkovaI,et al.Long-term patency of twisted vascular pedicles in perforator-based propeller flaps[J].Plast Reconstr Surg Glob Open,2017,5(10):e1544.DOI: 10.1097/GOX.0000000000001544.
    [14]
    PengP, DongZG, WeiJW,et al. Risk factors related to the partial necrosis of the posterior tibial artery perforator-plus fasciocutaneous flap[J].Eur J Trauma Emerg Surg,2022,48(2):1247-1253. DOI: 10.1007/s00068-021-01616-0.
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