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

Abstract

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.

Modified distally based peroneal artery perforator flap for reconstruction of foot and ankle

“…Currently, there are three types of distally based lower leg flaps: 1) the distally based reverse-flow island flap, such as the posterior tibial artery flap, the anterior tibial artery flap, and the peroneal artery flap; 9,10 2) the distally based perforator flap in which sacrifice of the main arteries can be avoided, such as the lateral and medial supramalleolar perforator flap; 11À13 and 3) the distally based neuro-veno-fasciocutaneous flap that is supplied by the chain-linked longitudinal directed vascular plexuses of the neuro-veno-adipofascial pedicle. 14,15 These flaps can be raised easily and substituted for microsurgical flaps for distal lower leg and foot and ankle reconstruction in certain circumstances. However, some complications have been reported, such as flap congestion and partial flap failure caused by inadequate venous return, complete flap failure caused by torsion or compression of the wide and thick adipofascial pedicle under subcutaneous tunnel, and donor site morbidity.…”

Distally based radial forearm flap with preservation of the radial artery: Anatomic, experimental, and clinical studies

“…36 Chain-linked vascularization of the integument is a specific type of blood supply in the distal forearm and lower leg. 37,38 Compared with axial and random-pattern flaps, link-pattern vascularized flaps have many unique characteristics. They can be considered as intermediate between axial and random (Table 2).…”

Missing medial tarsal artery replaced by the anterior medial malleolar artery

“…Two or three medial tarsal arteries (MTAs) ramify on the medial border of the foot and join the medial malleolar arterial network, whereas the lateral tarsal artery runs laterally under the extensor digitorum brevis, which supplies this muscle and the tarsal articulations, and anastomoses with branches of the arcuate, anterior lateral malleolar, and lateral plantar arteries, as well as the per orating fibular artery branch [3][4][5]. The MTA joins the anterior medial malleolar artery (AMMA) with the posterior medial malleolar artery and medial plantar artery branches [6]. However, there have been few descriptions of the coursing patterns and variations of the MTA.…”