CC BY-NC 4.0 · Arch Plast Surg 2020; 47(02): 165-170
DOI: 10.5999/aps.2019.00962
Original Article

The suprafascial course of lower leg perforators: An anatomical study

Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
,
Giuseppe Cottone
Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti, Ancona, Italy
,
Francesco De Francesco
Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
,
Francesco Borelli
Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
,
Giovanna Zaccaria
Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
,
Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
› Author Affiliations

Background Perforator mapping has been well described in the literature. Once the suprafascial plane is reached, the course of perforators is considered constant. However, the surgeon must be aware of whether an anastomosis exists between perforators superficially to the fascia, in order to choose the best vessel upon which to base the reconstruction. Our retrospective in vivo anatomical study of lower leg perforator flaps presents the first description of variations in the suprafascial path of perforators, which may influence preoperative flap design.

Methods An anatomical study of lower limb perforators was performed on 46 nonconsecutive patients who were referred to our department from June 2012 to October 2018. Reconstruction with perforator-based propeller flaps was planned for each of the patients. In total, 72 perforators were preoperatively identified and surgically isolated. The suprafascial course of each perforator was reported.

Results During suprafascial surgical exploration, branching patterns were observed in four perforators. These perforators had been classified as single vessels in the preoperative ultrasonographic analysis. However, after surgical dissection, distal converging branches were noted in two of them.

Conclusions Our study is the first description in the literature of suprafascial converging perforators, which might constitute an obstacle to planned reconstruction procedures. Despite the accuracy of preoperative evaluations, anatomical variations were present. Knowledge of suprafascial perforator variations may help surgeons to choose the correct perforator upon which to base a planned flap.



Publication History

Received: 12 July 2019

Accepted: 13 February 2020

Article published online:
22 May 2022

© 2020. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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