Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg

Nen, D. Le; Beal, David D.; Person, H.; Lefèvre, Christian; Senecail, B.

doi:10.1007/bf01627913

Cited by 17 publications

(13 citation statements)

References 4 publications

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“…However, our study revealed in 80% of cases a distinct branch as well as several smaller branches. Our findings are consistent w i t h o t h e r i n v e s t i g a t i o n s who observed malleolar branches originating from the level of the ankle joint-line to about 5 cm proximal to it [6,11,12,17,19,34].…”

Section: Discussionsupporting

confidence: 91%

The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap

et al. 1999

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Based on 30 fresh cadaver dissections a detailed anatomic study of the medial malleolar network is presented with particular attention to the anastomoses between the latter and the vascular axis that follows the saphenous nerve. The medial malleolar network is formed by the anterior medial malleolar artery, branches from the medial tarsal arteries, the posterior medial malleolar artery and branches from the medial plantar artery. A distinct anterior medial malleolar artery and posterior medial malleolar artery could be identified in 80 and 20%, respectively, as well as constant additional small branches arising from the anterior tibial or posterior tibial artery. A constant anastomosis was found between the arcade formed by the medial tarsal arteries and the medial plantar a. in 60%, and the medial branch of the medial plantar artery in 40%, respectively. This anastomosis always gave rise to branches to the medial malleolar network. In the perimalleolar area and with regard to the great saphenous v. a larger anterior and a smaller posterior branch of the saphenous nerve was found in 100 and 90%, respectively. In all dissections, for both branches of the saphenous nerve two to four small, but distinct anastomoses between the medial malleolar network and the perineural vascular axis were identified. These constant anastomoses represent a new and reliable vascular base for the distally-based saphenous neurocutaneous island flap. Thus, the pivotal point of the flap can be chosen in the area of the medial malleolus without respecting the most distal septocutaneous anastomosis between the perineural vascular axis and the posterior tibial artery. Additionally, an illustrative clinical case is presented.

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Section: Discussionsupporting

confidence: 91%

The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap

et al. 1999

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“…The potential problems of the flap [ 9 ] include some amount of venous congestion in reversed island flaps, painful neuroma as a result of a lesion of the superficial peroneal nerve, anatomic vascular variations [ 9 , [14] , [16] , [17] , [18] , [19] , [20] , [21] ], and the donor site concern, especially in young women. The usefulness of lateral supramalleolar flap has been demonstrated by its use as a delay flap [ 19 , 22 ] for tendon Achilles' coverage in difficult situations like Werner's syndrome, coverage of ischemic ulcer in Buerger's disease [ 20 ], as a free flap for oral coverage [ 14 ] and limb reconstruction [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Certain anatomic variations of the flap include the inconstant but frequent presence of a proximal inferolateral collateral artery [ 16 , 17 ], variations in the level of anastomosis between the perforating branch of the peroneal artery and the anterolateral malleolar artery arising from the anterior tibial artery, presence of the anterior peroneal artery, presence of a vascular network instead of a well-defined artery, absence of the perforating branch of the peroneal artery [ 16 , 17 ] and the basis of cutaneous circulation solely on anterior tibial perforators.…”

Section: Discussionmentioning

confidence: 99%

Lateral supramalleolar flap: Is it based on perforator of peroneal / anterior tibial artery; A cross-sectional study at tertiary care centre

Hashmi

Ahmed

Ali

et al. 2021

Annals of Medicine and Surgery

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Background To determine the anatomical basis of supramalleolar flap; retrograde versus antegrade and its clinical outcome based on the vascular pattern. Methods This analytic cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients who underwent coverage of soft tissue defects around the foot and ankle with supramalleolar flaps were included. Data collection was through medical records including demographic parameters, mechanism of injury, per-operative findings of perforator origin, and patient interviewing for final assessment. Patients with peripheral vascular disease, unavailability of skin, and radiation injuries were excluded. All analysis was done using SPSS version 25.0. Results 49 patients were included in the study from May 1999 to December 2020. The male to female ratio was 37:12. The cause of soft tissue defects was trauma in 9 (38.7%) followed by Infection in 16 (32.6%) and Blast injury in 5 cases (10.2%). The maximum flap size harvested was 20 × 8 cm. In 19 cases the peroneal artery perforator was absent and the flap was based on the perforator of an anterolateral malleolar branch (antegrade) while the remaining 30 flaps were based on the perforator of the peroneal artery (retrograde ). Overall, the flap survival rate was 98%; as 1 case had partial necrosis and required skin grafting. However, there were 9 minor complications. In 8 patients, the flap was rotated as a ‘ delay flap’ . All patients had satisfactory functional outcomes without significant morbidity of the donor site. Conclusion The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, as only 2 patients required defatting for cosmetic reasons. Microvascular expertise was required for a predictable outcome.

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“…For patients who have cosmetic consideration, perforator-based adipofascial flap is also a good option with the use of ASMA. [ 20 21 22 23 24 ]…”

Section: Discussionmentioning

confidence: 99%

Anatomical study of anterior supramalleolar artery and its potential application to design a bi-foliate fasciocutaneous flap

Chen

Kumar

et al. 2015

Indian J Plast Surg

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Purpose:A further understanding of the anterior supramalleolar artery (ASMA) and its potential applications in reconstructive surgery.Materials and Methods:A total of 24 fresh lower limbs from fresh cadavers were injected with red latex for dissection. The type of origin, course, diameter of the pedicle, and the distance between the origin of the ASMA from the anterior tibial artery to the extensor retinaculum (O-R) were recorded. Bi-foliate fasciocutaneous flaps were harvested using the branches of the ASMA.Results:We found four types of origin of the ASMA, and we have accordingly classified them into four types. 10 of them were type A, 7 were type B, 6 were type C and 1 was type D. The mean O-R (origin of ASMA to retinaculum) distance was 2.0 ± 0.8 cm. The diameter of the medial branch (D1), the diameter of the lateral branch (D2), and the diameter of artery stem (D3) (only in type A) were 1.0 ± 0.2 mm, 0.8 ± 0.3 mm, 1.1 ± 0.2 mm, respectively. The mean pedicle length of the lateral flap (L1) and medial flap (L2) were 5.1 ± 1.0 cm and 3.7 ± 0.6 cm, respectively.Conclusions:The ASMA exists constantly with four different types of origin. Its sizable diameter and lengthy pedicle make it suitable for bi-foliate fasciocutaneous flap transfer.

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Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg

Cited by 17 publications

References 4 publications

The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap

The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap

Lateral supramalleolar flap: Is it based on perforator of peroneal / anterior tibial artery; A cross-sectional study at tertiary care centre

Anatomical study of anterior supramalleolar artery and its potential application to design a bi-foliate fasciocutaneous flap

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