Absence of the posterior tibial artery: implications for free transplants of the fibula

Abstract

A well-documented case of absence of the posterior tibial a. is reported. We have studied 40 personal case-records of dissection of the arteries of the leg in fresh corpses. This study allowed classification of the origins of the leg arteries from the popliteal a. into 7 groups. Several findings emerged: 1) the peroneal a. is constant, for phylogenetic and embryologic reasons, 2) the posterior tibial a. is absent in 1 to 5% of cases [1, 2, 4, 6-8] (Fig. 4), in which case the vascularisation of the fibula remains as normal (the proximal epiphysis of the fibula is vascularised by the anterior tibial a., the diaphysis and the distal epiphysis by the peroneal a.). Other anatomic variations may be found: trifurcation of the popliteal a., origin of the anterior tibial a. from the peroneal a., absence of the anterior tibial a., aplasia of the terminal portions of both the anterior and posterior tibial aa. In practice, absence of the posterior tibial a. can be demonstrated by arteriography and doppler ultrasound. We are dubious about the indications for arteriography, which is not always a risk-free examination, and therefore prefer doppler examination with ultrasound, which supplies adequate information in the majority of cases.

Anatomical variants of lower limb vasculature and implications for free fibula flap: Systematic review and critical analysis

“…Seven cadaveric and 19 clinical radiographic studies were found eligible for inclusion, with average sample size of 113 and 263 limbs, respectively (Table ). Conventional dissection was performed in all the cadaveric studies, and was supplemented with postmortem angiography in one study . In the radiographic studies, catheter arteriography (CA) was the commonest modality used in 12 studies.…”

“…Conventional dissection was performed in all the cadaveric studies, and was supplemented with postmortem angiography in one study. 30 In the radiographic studies, catheter arteriography (CA) was the commonest modality used in 12 studies. Magnetic resonance angiography (MRA) and multidetector row computed tomographic angiography (MDCTA) were used in four and three studies, respectively.…”

Fibula Osteoseptocutaneous Flap

“…Once it has been visualized that the posterior tibialis artery is present, harvest of the fibula flap may proceed without any concern for devascularizing the leg. 21,22 It should be noted that with the anterior approach for this procedure, visualization of the tibioperoneal trunk occurs after performing the osteotomies and dissecting the whole length of the pedicle. Thus, aborting the procedure due to diagnosis of peroneum magnum via the anterior approach is far more morbid than with the posterior approach.…”

Hypoplastic posterior tibial artery and the enlarged peroneal artery supplying the posterior crural region: a rare variation

“…The vascularization of fibula remains normal even in the absence of PT since the nutrient artery to fibula is provided by the PR. 10 But harvesting of the peroneal artery in vascularized fibular grafting 19 would be contraindicated in rare type III infrapopliteal patterns, particularly when the PR is the only artery to supply the foot. It may be necessary to modify the angioplasty technique to take account of the absence of vessels in order to minimize risk of complications.…”

“…[3][4][5] The incidence of hypoplastic-aplastic PT ranges between 0.8-3.8% in the angiographic studies whereas in the anatomical studies it ranges between 1.5-11%. [1][2][3][6][7][8][9][10] Compensatory hypertrophy of the PR with a hypoplastic or aplastic PT or AT may indicate variant arterial supply to the foot. 1 This enlarged PR, the "peronea magna" or "great" peroneal artery as described by Senior, either joins and reinforces the PT or replaces it in the distal leg and foot.…”