ABSTRACT
When free tissue transfer is employed for defects of the lower third of the leg, recipient
anastomoses are typically performed to major vessels. The aim of this study was to
assess soleal perforators located in the distal half of the leg as potential vessels
for free flap recipient vessels. Six fresh cadavers (12 limbs) were dissected. Perforators
of adequate size (≥1 mm) were documented as was the location and ease of dissection.
Lower extremity magnetic resonance angiograms (MRAs) of 18 extremities were retrospectively
reviewed. Two free tissue transfers to lower extremity perforators were presented.
Soleal perforators most reliably matched our recipient vessel requirements. Perforators
were of adequate size to support free tissue transfer, easy to dissect, and were located
at mid/distal fibula level. MRA evaluation confirmed these results. One free tissue
reconstruction was performed for trauma (posterior tibial perforator) and one was
performed for a chronic radiation wound (peroneal perforator). The soleus muscle is
easily exposed and is supplied distally by perforators from both the posterior tibial
and the peroneal artery systems. These perforating branches are more accessible than
the major lower extremity arteries, making the exposure and anastomosis technically
easier and sparing potential iatrogenic injury to critical vessels.
KEYWORDS
Perforator - recipient vessel - lower extremity reconstruction - microsurgery
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Pierre SaadehM.D.
Institute of Reconstructive Plastic Surgery, New York University Medical Center
560 First Avenue, TCH-169, New York, NY 10016
Email: Pierre.Saadeh@nyumc.org
