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.	張永祥, 魏在榮. 腓動脈穿支皮瓣的解剖與臨床應用研究進展. 中國臨床解剖學雜志, 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.	張世民, 徐達傳, 張發惠, 等. 外踝后穿支皮瓣. 中國臨床解剖學雜志, 2005, 23(4): 345-348, 356.
4.	楊學棟. 外踝上皮瓣皮支起源的臨床解剖學研究. 濟南: 山東大學, 2011.
5.	李匡文, 唐舉玉, 劉昌雄, 等. 腓動脈穿支皮瓣的應用解剖. 中國臨床解剖學雜志, 2011, 29(4): 382-385.
6.	張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 2017, 31(7): 769-772.
7.	徐永清, 何曉清. 皮瓣外科的新進展. 中國修復重建外科雜志, 2018, 32(7): 781-785.
8.	施洪臣, 章雪松, 李寶山, 等. 低旋轉點外踝上皮瓣修復前足軟組織缺損. 中國修復重建外科雜志, 2012, 26(6): 761-763.
9.	秦毅, 江建明, 秦杰. 穿支蒂腓淺神經營養血管皮瓣修復外踝部皮膚缺損. 中國臨床解剖學雜志, 2011, 29(3): 343-345.
10.	柴益民, 林崇正, 陳彥, 等. 腓動脈終末穿支蒂腓腸神經營養血管皮瓣的臨床應用. 中華顯微外科雜志, 2001, 24(3): 167-169.
11.	鄧葵, 黃跟東, 陳明, 等. 腓動脈穿支皮瓣修復兒童足跟部嚴重輪輻傷. 中華顯微外科雜志, 2018, 41(2): 145-147.
12.	張世民, 唐茂林, 穆廣態, 等. 穿支皮瓣及相關術語的專家共識. 中國臨床解剖學雜志, 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.	向劍平, 顧立強. 首屆全國顯微創傷骨科學術會議暨穿支皮瓣命名原則專題研討會紀要. 中華顯微外科雜志, 2011, 34(5): 353-354.
15.	陳雪松, 肖茂明, 王元山, 等. 腓動脈主穿支蒂腓腸神經營養血管皮瓣修復足踝部中小面積軟組織缺損. 中國修復重建外科雜志, 2009, 23(2): 212-214.
16.	王慎東, 魯彧, 周建芹, 等. 逆行腓動脈穿支筋膜蒂皮瓣和逆行脛后動脈穿支筋膜蒂皮瓣的效果比較. 中國矯形外科雜志, 2015, 23(20): 1854-1858.
17.	周洪翔, 陳亮, 李俊杰, 等. 改良螺旋槳穿支皮瓣在修復足跟周圍軟組織缺損中的應用. 中國矯形外科雜志, 2017, 25(6): 517-520.
18.	李木衛, 陳飛, 馬立峰, 等. 游離腓動脈穿支皮瓣修復足部供區創面的療效. 中國修復重建外科雜志, 2014, 28(3): 389-390.
19.	梁力, 黃東, 林浩, 等. 特殊形式的腓動脈穿支皮瓣設計的應用解剖. 廣東醫學, 2016, 37(9): 1321-1324.
20.	楊克勤, 莫勇軍, 譚海濤, 等. CTA 技術在小腿穿支皮瓣修復踝周組織缺損中的應用. 中華顯微外科雜志, 2017, 40(2): 168-171.
21.	王俞明, 耿峰, 汪濤, 等. 三維超聲造影血管重建在穿支皮瓣術前評估中的應用. 中國美容整形外科雜志, 2015, 26(5): 287-290.
22.	范新宇, 徐永清, 徐龍江, 等. 高頻彩超結合超聲造影技術在穿支皮瓣術前設計及評估中的應用. 中華顯微外科雜志, 2013, 36(4): 322-326.

1. 張永祥, 魏在榮. 腓動脈穿支皮瓣的解剖與臨床應用研究進展. 中國臨床解剖學雜志, 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. 張世民, 徐達傳, 張發惠, 等. 外踝后穿支皮瓣. 中國臨床解剖學雜志, 2005, 23(4): 345-348, 356.
4. 楊學棟. 外踝上皮瓣皮支起源的臨床解剖學研究. 濟南: 山東大學, 2011.
5. 李匡文, 唐舉玉, 劉昌雄, 等. 腓動脈穿支皮瓣的應用解剖. 中國臨床解剖學雜志, 2011, 29(4): 382-385.
6. 張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 2017, 31(7): 769-772.
7. 徐永清, 何曉清. 皮瓣外科的新進展. 中國修復重建外科雜志, 2018, 32(7): 781-785.
8. 施洪臣, 章雪松, 李寶山, 等. 低旋轉點外踝上皮瓣修復前足軟組織缺損. 中國修復重建外科雜志, 2012, 26(6): 761-763.
9. 秦毅, 江建明, 秦杰. 穿支蒂腓淺神經營養血管皮瓣修復外踝部皮膚缺損. 中國臨床解剖學雜志, 2011, 29(3): 343-345.
10. 柴益民, 林崇正, 陳彥, 等. 腓動脈終末穿支蒂腓腸神經營養血管皮瓣的臨床應用. 中華顯微外科雜志, 2001, 24(3): 167-169.
11. 鄧葵, 黃跟東, 陳明, 等. 腓動脈穿支皮瓣修復兒童足跟部嚴重輪輻傷. 中華顯微外科雜志, 2018, 41(2): 145-147.
12. 張世民, 唐茂林, 穆廣態, 等. 穿支皮瓣及相關術語的專家共識. 中國臨床解剖學雜志, 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. 向劍平, 顧立強. 首屆全國顯微創傷骨科學術會議暨穿支皮瓣命名原則專題研討會紀要. 中華顯微外科雜志, 2011, 34(5): 353-354.
15. 陳雪松, 肖茂明, 王元山, 等. 腓動脈主穿支蒂腓腸神經營養血管皮瓣修復足踝部中小面積軟組織缺損. 中國修復重建外科雜志, 2009, 23(2): 212-214.
16. 王慎東, 魯彧, 周建芹, 等. 逆行腓動脈穿支筋膜蒂皮瓣和逆行脛后動脈穿支筋膜蒂皮瓣的效果比較. 中國矯形外科雜志, 2015, 23(20): 1854-1858.
17. 周洪翔, 陳亮, 李俊杰, 等. 改良螺旋槳穿支皮瓣在修復足跟周圍軟組織缺損中的應用. 中國矯形外科雜志, 2017, 25(6): 517-520.
18. 李木衛, 陳飛, 馬立峰, 等. 游離腓動脈穿支皮瓣修復足部供區創面的療效. 中國修復重建外科雜志, 2014, 28(3): 389-390.
19. 梁力, 黃東, 林浩, 等. 特殊形式的腓動脈穿支皮瓣設計的應用解剖. 廣東醫學, 2016, 37(9): 1321-1324.
20. 楊克勤, 莫勇軍, 譚海濤, 等. CTA 技術在小腿穿支皮瓣修復踝周組織缺損中的應用. 中華顯微外科雜志, 2017, 40(2): 168-171.
21. 王俞明, 耿峰, 汪濤, 等. 三維超聲造影血管重建在穿支皮瓣術前評估中的應用. 中國美容整形外科雜志, 2015, 26(5): 287-290.
22. 范新宇, 徐永清, 徐龍江, 等. 高頻彩超結合超聲造影技術在穿支皮瓣術前設計及評估中的應用. 中華顯微外科雜志, 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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