Posterior Tibial Flap Research Articles

Clinical Studies on Free-Flap Transplantation Bridged by Both Antegrade and Retrograde Posterior Tibial Vessel Flaps from the Healthy Leg

Clinical Studies on Free-Flap Transplantation Bridged by Both Antegrade and Retrograde Posterior Tibial Vessel Flaps from the Healthy Leg

Experience with the distally based posterior tibial island flap

A series of ten patients is presented to demonstrate the use of the distally based posterior tibial island flap with or without a muscle component for reconstruction of the foot. Six patients had defects due to a road traffic accident, two had defects due to a work accident, one had extensive scar contractures after a deep burn and advanced Buerger’s disease in another. There was complete survival of all the flaps but one. Four flaps were fasciocutaneous and six myofasciocutaneous, including the medial hemisoleus muscle. This flap is very useful in lower extremity reconstruction, particularly in the lower third of the leg and foot due to its long vascular pedicle, availability of skin and muscle and ease of elevation. All the island flaps were based on the anastomosis between posterior tibial and peroneal arteries above the medial malleolus.

Comparative Study of Reverse Flow Island Flaps in the Lower Extremities—Peroneal, Anterior Tibial, and Posterior Tibial Island Flaps in 25 Patients

The reverse flow island flap is one of the most versatile reconstructive procedures in the lower extremity. There are three major arteries, the peroneal, the anterior tibial, and the posterior tibial artery, and a reverse flow island flap pedicled by each vessel and its intermuscular cutaneous perforators is available. Twenty-five reverse flow island flaps were clinically applied for soft tissue defects in the lower leg (10 peroneal, 8 anterior tibial, and 7 posterior tibial flaps). We report a comparative study of the characteristics and indications of the peroneal, anterior tibial, and posterior tibial reverse flow flaps. We conclude that the anterior tibial reverse flow flaps are more likely, without venous anastomosis, to become congested and necrose than the peroneal and posterior tibial flaps.

The Vasculature and Clinical Application of the Posterior Tibial Perforator—Based Flap

Use of the posterior tibial flap pedicled on the posterior tibial vessels has been described by several authors, but with it there is the major disadvantage of an unavoidable transection of the posterior tibial artery. To overcome this disadvantage, we anatomically studied the perforators from the posterior tibial artery and used posterior tibial perforator-based flaps clinically. Based on our anatomic study of 25 cadaveric legs, the cutaneous perforators were considered to be distributed from the distal to the proximal sides of the lower leg through the medial border of the tibia, and they were classified into three types: septocutaneous perforators mainly located in the distal third of the leg, muscle perforators located in the proximal half, and periosteal perforators in the proximal third of the leg. The average size and number of perforators was 0.8 mm and 3.1 in one leg, respectively. A considerable number were located at sites from 70 to 140 mm superior to the medial malleolus. Based on our clinical cases repaired with flaps, we consider this flap to be useful as a free flap for the repair of defects of the extremities and as an island flap for reconstruction of defects on the anteromedial aspect of the lower leg. The territory of the flap is relatively wide, being 19 x 13 cm. The long saphenous vein can be used safely as the venous drainage system in the case of free-flap transfer.

Reconstruction of the lower leg and foot with the reverse pedicled posterior tibial fasciocutaneous flap

The use of reverse flow island flaps for reconstructive surgery in the distal leg and foot represents an alternative to free flap transfer. This paper reports on the use of a reverse pedicled posterior tibial artery flap in four patients. The flap can reach any part of the foot.

Heel and Foot Reconstruction Using Reverse-flow Posterior Tibial Flap

Island flaps supplied by the intermuscular cutaneous perforator (IMCP) from a deep vessel, such as the peroneal flap pedicled by IMCP from the peroneal vessel or the anterior tibial flap supplied by IMCP from the anterior tibial vessel, are reported to be useful in reconstructive procedures for soft-tissue defects of the lower leg. However, the posterior tibial flap, pedicled by IMCP from the posterior tibial vessel, has not yet been fully described. The posterior tibial flap can be used either as a normal-flow or as a reverse-flow flap. It is particularly versatile as a reverse-flow flap for reconstruction of soft-tissue defects of the heel and foot. Three reverse-flow posterior tibial flaps were clinically applied, without venous anastomosis, to reconstruct heel and foot defects, and all three survived completely. The operative procedure and its characteristics are described.

Resurfacing Difficult Wounds: Selective Use of the Posterior Tibial Flap

The posterior tibial flap is a type C fasciocutaneous flap from the medial calf with the posterior tibial vascular bundle as its pedicle. Most of the skin perforators, 1 to 3 in number, can be found in the middle third of the leg, with an average diameter of 0.8 mm and an average length of 22 mm. The posterior tibial artery ranges between 1.5 and 2.0 mm in diameter, although it is absent in 8 percent of limbs. Since the saphenous nerve is taken with the flap, this is an innervated flap. The flap can be transferred as a free flap or a pedicled flap. The reversed-flow pedicled flap has an average pedicle length of 8 cm. The posterior tibial flap is a reliable, large, thin, innervated flap and can be raised with the patient supine. Case reports are presented of six patients who received a free flap transfer and of one patient who received a reversed-flow pedicled flap. There were two cases of heel ulcerations, two crushed hands, one chronic ulceration and osteomyelitis of the tibia, one burn contracture of the neck, and one salvage flap for diabetic gangrene of the hand.