Computed Tomographic Angiography for Localization of the Cutaneous Perforators of the Leg

Abstract

Results of vascular anatomical studies of the lower limb in the past have been primarily descriptive in nature and are therefore less useful in directing the design of local perforator-based flaps. The purpose of this study was to document the three-dimensional anatomy of the cutaneous perforators arising from the anterior tibial, posterior tibial, and peroneal arteries and provide a statistically verified method for predicting perforator location for use in the clinical setting. Computed tomographic angiography and three-dimensional reconstructions of the lower limb using Mimics software were completed for five lead oxide-injected cadavers. The cutaneous perforators of the vessels of the tibial trunk were identified, and perforator diameter, course, and location relative to leg length were determined. Cluster analysis was performed to evaluate the consistency of perforator locations across individuals. The anterior tibial artery had the greatest number of perforator vessels, which clustered into three groups centered at 83 ± 6 percent (percent of tibial height ± SD), 59 ± 7 percent, and 28 ± 9 percent. Peroneal artery perforators were clustered in two groups centered at 61 ± 9 percent and 27 ± 11 percent. The posterior tibial artery perforators could also be divided into two groups; however, a larger SD in the two groups suggests that perforators arising from this vessel are more evenly spaced. Statistical analysis demonstrated that the major perforator vessels of the tibial trunk are conserved across individuals and can be reliably dissected using the cluster's statistical distribution. Results of this study will allow for better preoperative planning of local flaps.