Anatomy and clinical application of anterior and posterior terminal perforators of peroneal artery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Tao ¹ ,  HAN Zhaofeng ¹ , ZHOU Mingwu ² , LI Shimin ² , SONG Jian ² , HU Zhiyu ² , ZHANG Guangchao ²

1. Department of Plastic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China;
2. Department of Trauma Microsurgery, No.988 Hospital of Joint Logistic Support Force, Zhengzhou Henan, 450042, P.R.China;

Corresponding author：

HAN Zhaofeng, Email: hanzf76@126.com

Keywords：

Peroneal artery perforator flap; terminal perforator; contrast-enhanced ultrasound; lateral malleolus region

DOI：

10.7507/1002-1892.201904046

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Objective To investigate the anatomy of anterior and posterior terminal perforators of the peroneal artery and its clinical applications. Methods Six lower limb specimens were obtained from 3 fresh cadavers. The anterior and posterior terminal perforators and the perforator of terminal peroneal artery were exposed under surgical microscope, and the distances from the beginning of each perforator branch to the lateral malleolus tip and the external diameter of each perforator were measured. With these anatomical knowledge and contrast-enhanced ultrasound (CEUS) guidance, the pedicle flaps with above-mentioned perforators were rationally selected and precisely designed for 18 patients with skin defects in the ankle and foot region between October 2016 and December 2018. Among the patients, there were 14 males and 4 females, aged 28-62 years, with an average age of 40 years. The area of wound ranged from 4 cm×3 cm to 13 cm×10 cm and the area of skin flap ranged from 5 cm×4 cm to 14 cm×10 cm. The anterior peroneal artery terminal perforator flap were applied in 13 cases and the posterior peroneal artery terminal perforator flap in 5 cases. The donor sites were closed directly in 7 cases and repaired with full thickness skin graft in 11 cases. Results The distance from the beginning of the anterior terminal perforator to the lateral malleolus tip was (5.1±0.5) cm, the external diameter of the anterior terminal perforator was (1.51±0.05) mm. The distance from the beginning of the posterior terminal perforator to the lateral malleolus tip was (4.9±0.9) cm, the external diameter was (1.78±0.17) mm; the distance from the beginning of the perforator of terminal peroneal artery to the lateral malleolus tip was (1.7±0.7) cm, the external diameter was (0.58±0.12) mm. Clinical application results: The edge of the flap was dark in 2 cases after operation and healed after surgical dressing, and 1 case of wound infection healed gradually after debridement. The other flaps survived and healed by first intention. Three patients underwent plastic surgery at 3 months after operation due to flap swelling. All patients were followed up 3-18 months. During the follow-up period, the flaps had good texture and appearance, and partial recovery of sensation. All cases were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score at last follow-up. The results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 83.3%. Conclusion Further classification of peroneal artery perforators in the lateral malleolus region can improve clinical understanding and be helpful to selection and application of perforator flaps in the lateral malleolus.

Citation： YANG Tao, HAN Zhaofeng, ZHOU Mingwu, LI Shimin, SONG Jian, HU Zhiyu, ZHANG Guangchao. Anatomy and clinical application of anterior and posterior terminal perforators of peroneal artery. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1156-1161. doi: 10.7507/1002-1892.201904046 Copy

1.	张永祥, 魏在荣. 腓动脉穿支皮瓣的解剖与临床应用研究进展. 中国临床解剖学杂志, 2015, 33(3): 371-374.
2.	Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer. Plast Reconstr Surg, 1990, 85(6): 917-921.
3.	张世民, 徐达传, 张发惠, 等. 外踝后穿支皮瓣. 中国临床解剖学杂志, 2005, 23(4): 345-348, 356.
4.	杨学栋. 外踝上皮瓣皮支起源的临床解剖学研究. 济南: 山东大学, 2011.
5.	李匡文, 唐举玉, 刘昌雄, 等. 腓动脉穿支皮瓣的应用解剖. 中国临床解剖学杂志, 2011, 29(4): 382-385.
6.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
7.	徐永清, 何晓清. 皮瓣外科的新进展. 中国修复重建外科杂志, 2018, 32(7): 781-785.
8.	施洪臣, 章雪松, 李宝山, 等. 低旋转点外踝上皮瓣修复前足软组织缺损. 中国修复重建外科杂志, 2012, 26(6): 761-763.
9.	秦毅, 江建明, 秦杰. 穿支蒂腓浅神经营养血管皮瓣修复外踝部皮肤缺损. 中国临床解剖学杂志, 2011, 29(3): 343-345.
10.	柴益民, 林崇正, 陈彦, 等. 腓动脉终末穿支蒂腓肠神经营养血管皮瓣的临床应用. 中华显微外科杂志, 2001, 24(3): 167-169.
11.	邓葵, 黄跟东, 陈明, 等. 腓动脉穿支皮瓣修复儿童足跟部严重轮辐伤. 中华显微外科杂志, 2018, 41(2): 145-147.
12.	张世民, 唐茂林, 穆广态, 等. 穿支皮瓣及相关术语的专家共识. 中国临床解剖学杂志, 2010, 28(5): 475-477.
13.	Wang CY, Chai YM, Wen G, et al. One-stage reconstruction of composite extremity defects with a sural neurocutaneous flap and a vascularized fibular graft: a novel chimeric flap based on the peroneal artery. Plast Reconstr Surg, 2013, 132(3): 428e-437e.
14.	向剑平, 顾立强. 首届全国显微创伤骨科学术会议暨穿支皮瓣命名原则专题研讨会纪要. 中华显微外科杂志, 2011, 34(5): 353-354.
15.	陈雪松, 肖茂明, 王元山, 等. 腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小面积软组织缺损. 中国修复重建外科杂志, 2009, 23(2): 212-214.
16.	王慎东, 鲁彧, 周建芹, 等. 逆行腓动脉穿支筋膜蒂皮瓣和逆行胫后动脉穿支筋膜蒂皮瓣的效果比较. 中国矫形外科杂志, 2015, 23(20): 1854-1858.
17.	周洪翔, 陈亮, 李俊杰, 等. 改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用. 中国矫形外科杂志, 2017, 25(6): 517-520.
18.	李木卫, 陈飞, 马立峰, 等. 游离腓动脉穿支皮瓣修复足部供区创面的疗效. 中国修复重建外科杂志, 2014, 28(3): 389-390.
19.	梁力, 黄东, 林浩, 等. 特殊形式的腓动脉穿支皮瓣设计的应用解剖. 广东医学, 2016, 37(9): 1321-1324.
20.	杨克勤, 莫勇军, 谭海涛, 等. CTA 技术在小腿穿支皮瓣修复踝周组织缺损中的应用. 中华显微外科杂志, 2017, 40(2): 168-171.
21.	王俞明, 耿峰, 汪涛, 等. 三维超声造影血管重建在穿支皮瓣术前评估中的应用. 中国美容整形外科杂志, 2015, 26(5): 287-290.
22.	范新宇, 徐永清, 徐龙江, 等. 高频彩超结合超声造影技术在穿支皮瓣术前设计及评估中的应用. 中华显微外科杂志, 2013, 36(4): 322-326.

1. 张永祥, 魏在荣. 腓动脉穿支皮瓣的解剖与临床应用研究进展. 中国临床解剖学杂志, 2015, 33(3): 371-374.
2. Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer. Plast Reconstr Surg, 1990, 85(6): 917-921.
3. 张世民, 徐达传, 张发惠, 等. 外踝后穿支皮瓣. 中国临床解剖学杂志, 2005, 23(4): 345-348, 356.
4. 杨学栋. 外踝上皮瓣皮支起源的临床解剖学研究. 济南: 山东大学, 2011.
5. 李匡文, 唐举玉, 刘昌雄, 等. 腓动脉穿支皮瓣的应用解剖. 中国临床解剖学杂志, 2011, 29(4): 382-385.
6. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
7. 徐永清, 何晓清. 皮瓣外科的新进展. 中国修复重建外科杂志, 2018, 32(7): 781-785.
8. 施洪臣, 章雪松, 李宝山, 等. 低旋转点外踝上皮瓣修复前足软组织缺损. 中国修复重建外科杂志, 2012, 26(6): 761-763.
9. 秦毅, 江建明, 秦杰. 穿支蒂腓浅神经营养血管皮瓣修复外踝部皮肤缺损. 中国临床解剖学杂志, 2011, 29(3): 343-345.
10. 柴益民, 林崇正, 陈彦, 等. 腓动脉终末穿支蒂腓肠神经营养血管皮瓣的临床应用. 中华显微外科杂志, 2001, 24(3): 167-169.
11. 邓葵, 黄跟东, 陈明, 等. 腓动脉穿支皮瓣修复儿童足跟部严重轮辐伤. 中华显微外科杂志, 2018, 41(2): 145-147.
12. 张世民, 唐茂林, 穆广态, 等. 穿支皮瓣及相关术语的专家共识. 中国临床解剖学杂志, 2010, 28(5): 475-477.
13. Wang CY, Chai YM, Wen G, et al. One-stage reconstruction of composite extremity defects with a sural neurocutaneous flap and a vascularized fibular graft: a novel chimeric flap based on the peroneal artery. Plast Reconstr Surg, 2013, 132(3): 428e-437e.
14. 向剑平, 顾立强. 首届全国显微创伤骨科学术会议暨穿支皮瓣命名原则专题研讨会纪要. 中华显微外科杂志, 2011, 34(5): 353-354.
15. 陈雪松, 肖茂明, 王元山, 等. 腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小面积软组织缺损. 中国修复重建外科杂志, 2009, 23(2): 212-214.
16. 王慎东, 鲁彧, 周建芹, 等. 逆行腓动脉穿支筋膜蒂皮瓣和逆行胫后动脉穿支筋膜蒂皮瓣的效果比较. 中国矫形外科杂志, 2015, 23(20): 1854-1858.
17. 周洪翔, 陈亮, 李俊杰, 等. 改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用. 中国矫形外科杂志, 2017, 25(6): 517-520.
18. 李木卫, 陈飞, 马立峰, 等. 游离腓动脉穿支皮瓣修复足部供区创面的疗效. 中国修复重建外科杂志, 2014, 28(3): 389-390.
19. 梁力, 黄东, 林浩, 等. 特殊形式的腓动脉穿支皮瓣设计的应用解剖. 广东医学, 2016, 37(9): 1321-1324.
20. 杨克勤, 莫勇军, 谭海涛, 等. CTA 技术在小腿穿支皮瓣修复踝周组织缺损中的应用. 中华显微外科杂志, 2017, 40(2): 168-171.
21. 王俞明, 耿峰, 汪涛, 等. 三维超声造影血管重建在穿支皮瓣术前评估中的应用. 中国美容整形外科杂志, 2015, 26(5): 287-290.
22. 范新宇, 徐永清, 徐龙江, 等. 高频彩超结合超声造影技术在穿支皮瓣术前设计及评估中的应用. 中华显微外科杂志, 2013, 36(4): 322-326.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomy and clinical application of anterior and posterior terminal perforators of peroneal artery

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