The applied anatomy of posterior tibial artery cutaneous branches-chain flap

Abstract

Objective To provide anatomy information for harvesting the posterior tibial artery cutaneous branches-chain flaps. Methods The research was performed from January, 2017 to January, 2018. Anatomic observation on 10 legs from fresh human cadaver were performed. The location of cutaneous branches of the posterior tibial artery was observed and its diameter and length was measured. Five legs were prepared to investigate the cutaneous branches of posterior tibial artery. The anastomosis of cutaneous branches of posterior tibial artery was observed by PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography in 5 perfused legs. The cutaneous branches with diameter over 0.2 mm in 10 legs of latex perfusion microdissection were included in the statistical analysis. The data were clustered and analyzed to find the location of distant and near cutaneous branches, which was called the gathering point of cutaneous branch vascular plexus. Secondly, the measured data of distal and near segments containing cutaneous branches were compared by t-test. Then the distribution of cutaneous branches of posterior tibial artery on the tibiofibular side was compared by Chi-square test. It was considered to be significant if P value was under 0.05. Results ①There were 4.3 cutaneous branches raised from the posterior tibial artery. There was no significant difference on the tibial and ribula side distribution of the cutaneous branches from the posterior tibial artery(P>0.05). ②The distal cutaneous branch clusters was located at about 1/5 of the distal leg and there were 3.6 cutaneous branches raised from the posterior tibial artery. While the proximal clusters was located at 1/3 of the proximal leg and there were 0.7 cutaneous branches raised from the posterior tibial artery. There were no significant differences in the diameters (P=0.28) and pedicle length (P=0.14) between distal and proximal cutaneous branches. ③ There were the large cutaneous perforators (≥1.0) mm from the posterior tibial artery at (6.37±1.22) cm proximal to the medial malleolus. The diameter and pedicle length of the distal perforators were (1.11±0.09) mm and (6.53±1.51) mm respectively. ④ The vascular chains parallel to the posterior tibial artery were formed via anastomosis of the adjacent cutaneous perforators. Conclusion The cutaneous expenditure of posterior tibial artery is constant, with a certain pedicle length and diameter. There are 2 relatively dense vascular plexus of cutaneous branches. The proximal and distal vascular flaps can be designed with these 2 vascular dense points as rotation points. Key words: Posterior tibial artery; Cutaneous branches-chain flap; Shank; Applied anatomy