Anatomical study and clinical application of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects

Abstract

Objective To explore the anatomic basis of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects and report its clinical efficacy. Methods Microsurgical anatomical study was performed in 6 specimens of fresh Chinese adult lower extremities to observe and measure the branches, distribution, vessel length, caliber and venous valve characteristics of the anterior lateral malleolar venous network. From May 2007 to February 2017, 15 patients with superficial palmar arch defects were treated by anterior lateral malleolar venous network graft. Results Anatomical study results showed that there was a obviously visible venous network in the superficial fascia of the anterior lateral malleolus. The distal end was originated from the fibular side of the arcus venosus dorsalis pedis, and the proximal vessels flowed into the great saphenous vein medially and the small saphenous vein laterally. Between them, there were 4 to 6 fine veins that formed network. The length of the distal dorsal segment of small saphenous vein (BC) was (2.81±0.39) cm. The branch length of the anterior lateral malleolar venous network (CD) was (5.32±0.92) cm. The fibular side vascular diameter of arcus venosus dorsalis pedis was (2.15±0.35) mm. The proximal end of the vascular network had 4.8 branches. The diameter of the vascular branch at the tip of the lateral malleolus E line horizon averaged (1.06±0.43) mm. There are an average of 4.2 valves per anterior lateral malleolar venous network. The valves in branches are toward the proximal direction. Clinically, 15 cases of superficial palmar arch defects were treated by anterior lateral malleolar venous network graft with a total of 54 anastomosis sites of distal area of recipient area and an average of 3.6 anastomosis sites per case. Postoperatively, 1 case suffered partial distal thumb necrosis and the rest of the distal fingers survived uneventfully. The follow-up time ranged from 6 months to 5 years and 3 months in 12 cases. The appearance of the hand was good, and the function of holding and opposition movement was restored. The finger proprioceptive sense was recovered. The two-point discrimination was 5 to 7 mm. According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 6 cases, good in 4 cases, fair in 1 case and poor in 1 case. There was no influence on the function of donor site. Conclusion The anatomy of anterior lateral malleolar venous network is constant. Its shape, diameter and number of branches are similar to the superficial palmar arch. The valve opening is toward the proximal end. It is an ideal method for repairing the defects of superficial palmar arch. Key words: Dissection; Vascular grafting; Venous network; Superficial palmar arch