CC BY-NC-ND 4.0 · Indian J Plast Surg 2015; 48(01): 017-021
DOI: 10.4103/0970-0358.155262
Original Article
Association of Plastic Surgeons of India

Anatomical study of anterior supramalleolar artery and its potential application to design a bi-foliate fasciocutaneous flap

Ji-Yin He
1   Department of Plastic Surgery, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
,
Shih-Heng Chen
2   Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
,
Kannan Karuppiah Kumar
3   Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA
,
Zhi-Hong Fan
1   Department of Plastic Surgery, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
,
Jie Lao
4   Department of Hand Surgery, Huashan Hospital Affiliated Fudan University, Shanghai, China
,
Huey Tien
3   Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA
› Author Affiliations
Further Information

Address for correspondence:

Dr. Huey Tien
Christine M. Kleinert Institute for Hand and Microsurgery
225 Abraham Flexner Way, Louisville, Kentucky 40202
USA   

Publication History

Publication Date:
26 August 2019 (online)

 

ABSTRACT

Purpose: A further understanding of the anterior supramalleolar artery (ASMA) and its potential applications in reconstructive surgery. Materials and Methods: A total of 24 fresh lower limbs from fresh cadavers were injected with red latex for dissection. The type of origin, course, diameter of the pedicle, and the distance between the origin of the ASMA from the anterior tibial artery to the extensor retinaculum (O-R) were recorded. Bi-foliate fasciocutaneous flaps were harvested using the branches of the ASMA. Results: We found four types of origin of the ASMA, and we have accordingly classified them into four types. 10 of them were type A, 7 were type B, 6 were type C and 1 was type D. The mean O-R (origin of ASMA to retinaculum) distance was 2.0 ± 0.8 cm. The diameter of the medial branch (D1), the diameter of the lateral branch (D2), and the diameter of artery stem (D3) (only in type A) were 1.0 ± 0.2 mm, 0.8 ± 0.3 mm, 1.1 ± 0.2 mm, respectively. The mean pedicle length of the lateral flap (L1) and medial flap (L2) were 5.1 ± 1.0 cm and 3.7 ± 0.6 cm, respectively. Conclusions: The ASMA exists constantly with four different types of origin. Its sizable diameter and lengthy pedicle make it suitable for bi-foliate fasciocutaneous flap transfer.


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Conflicts of interest

None declared.

  • REFERENCES

  • 1 Ballmer FT, Hertel R, Noetzli HP, Masquelet AC. The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap. Surg Radiol Anat 1999; 21: 297-303
  • 2 Ozdemir R, Kocer U, Sahin B, Oruc M, Kilinc H, Tekdemir I. Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use. Plast Reconstr Surg 2006; 117: 1619-30
  • 3 Ozalp T, Masquelet AC, Begue TC. Septocutaneous perforators of the peroneal artery relative to the fibula: Anatomical basis of the use of pedicled fasciocutaneous flap. Surg Radiol Anat 2006; 28: 54-8
  • 4 Vazquez T, Rodríguez-Niedenfuhr M, Parkin I, Viejo F, Sanudo J. Anatomic study of blood supply of the dorsum of the foot and ankle. Arthroscopy 2006; 22: 287-90
  • 5 Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985; 76: 354-63
  • 6 Masquelet AC, Beveridge J, Romana C, Gerber C. The lateral supramalleolar flap. Plast Reconstr Surg 1988; 81: 74-81
  • 7 Sham E, Choi WT, Flood SJ. Lateral supramalleolar flap in reconstruction of pressure ulcers in patients with spinal cord injury. ANZ J Surg 2008; 78: 167-71
  • 8 Hamdi MF, Khlifi A. Lateral supramalleolar flap for coverage of ankle and foot defects in children. J Foot Ankle Surg 2012; 51: 106-9
  • 9 Akita S, Mitsukawa N, Rikihisa N, Himeta J, Kubota Y, Shimada N. et al. Descending branch of the perforating branch of the peroneal artery perforator-based island flap for reconstruction of the lateral malleolus with minimal invasion. Plast Reconstr Surg 2013; 132: 461-9
  • 10 Masquelet AC, Romana MC. The medialis pedis flap: A new fasciocutaneous flap. Plast Reconstr Surg 1990; 85: 765-72
  • 11 Satoh K, Sakai M, Hiromatsu N, Ohsumi N. Heel and foot reconstruction using reverse-flow posterior tibial flap. Ann Plast Surg 1990; 24: 318-27
  • 12 Koshima I, Soeda S. Free posterior tibial perforator-based flaps. Ann Plast Surg 1991; 26: 284-8
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  • 14 Satoh K, Yoshikawa A, Hayashi M. Reverse-flow anterior tibial flap type III. Br J Plast Surg 1988; 41: 624-7
  • 15 Wee JT. Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap. Br J Plast Surg 1986; 39: 327-37
  • 16 Satoh K, Aoyama R, Onizuka T. Comparative study of reverse flow island flaps in the lower extremities - peroneal, anterior tibial, and posterior tibial island flaps in 25 patients. Ann Plast Surg 1993; 30: 48-56
  • 17 Koshima I, Yamamoto H, Moriguchi T, Kawada S, Ono Y. Combined anteroposterior tibial perforator-based flap with a vascularized deep peroneal nerve for repair of facial defect. Ann Plast Surg 1994; 33: 421-5
  • 18 Huber JF. The arterial network supplying the dorsum of the foot. Anat Rec 1941; 80: 373-91
  • 19 Koshima I, Itoh S, Nanba Y, Tsutsui T, Takahashi Y. Medial and lateral malleolar perforator flaps for repair of defects around the ankle. Ann Plast Surg 2003; 51: 579-83
  • 20 Le Nen D, Beal D, Person H, Lefevre C, Sénécail B. Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg. Surg Radiol Anat 1994; 16: 3-8
  • 21 Touam C, Rostoucher P, Bhatia A, Oberlin C. Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower one-fourth of the leg, the ankle, and the foot. Plast Reconstr Surg 2001; 107: 383-92
  • 22 Lee YH, Rah SK, Choi SJ, Chung MS, Baek GH. Distally based lateral supramalleolar adipofascial flap for reconstruction of the dorsum of the foot and ankle. Plast Reconstr Surg 2004; 114: 1478-85
  • 23 Kilinc H, Bilen BT, Arslan A. A novel flap to repair medial and lateral malleolar defects: Anterior tibial artery perforator-based adipofascial flap. Ann Plast Surg 2006; 57: 396-401
  • 24 Demirtas Y, Ayhan S, Sariguney Y, Findikcioglu F, Cukurluoglu O, Latifoglu O. et al. Distally based lateral and medial leg adipofascial flaps: Need for caution with old, diabetic patients. Plast Reconstr Surg 2006; 117: 272-6
  • 25 Gilbert BJ, Horst F, Nunley JA. Potential donor rotational bone grafts using vascular territories in the foot and ankle. J Bone Joint Surg Am 2004; 86-A: 1857-73

Address for correspondence:

Dr. Huey Tien
Christine M. Kleinert Institute for Hand and Microsurgery
225 Abraham Flexner Way, Louisville, Kentucky 40202
USA   

  • REFERENCES

  • 1 Ballmer FT, Hertel R, Noetzli HP, Masquelet AC. The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap. Surg Radiol Anat 1999; 21: 297-303
  • 2 Ozdemir R, Kocer U, Sahin B, Oruc M, Kilinc H, Tekdemir I. Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use. Plast Reconstr Surg 2006; 117: 1619-30
  • 3 Ozalp T, Masquelet AC, Begue TC. Septocutaneous perforators of the peroneal artery relative to the fibula: Anatomical basis of the use of pedicled fasciocutaneous flap. Surg Radiol Anat 2006; 28: 54-8
  • 4 Vazquez T, Rodríguez-Niedenfuhr M, Parkin I, Viejo F, Sanudo J. Anatomic study of blood supply of the dorsum of the foot and ankle. Arthroscopy 2006; 22: 287-90
  • 5 Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985; 76: 354-63
  • 6 Masquelet AC, Beveridge J, Romana C, Gerber C. The lateral supramalleolar flap. Plast Reconstr Surg 1988; 81: 74-81
  • 7 Sham E, Choi WT, Flood SJ. Lateral supramalleolar flap in reconstruction of pressure ulcers in patients with spinal cord injury. ANZ J Surg 2008; 78: 167-71
  • 8 Hamdi MF, Khlifi A. Lateral supramalleolar flap for coverage of ankle and foot defects in children. J Foot Ankle Surg 2012; 51: 106-9
  • 9 Akita S, Mitsukawa N, Rikihisa N, Himeta J, Kubota Y, Shimada N. et al. Descending branch of the perforating branch of the peroneal artery perforator-based island flap for reconstruction of the lateral malleolus with minimal invasion. Plast Reconstr Surg 2013; 132: 461-9
  • 10 Masquelet AC, Romana MC. The medialis pedis flap: A new fasciocutaneous flap. Plast Reconstr Surg 1990; 85: 765-72
  • 11 Satoh K, Sakai M, Hiromatsu N, Ohsumi N. Heel and foot reconstruction using reverse-flow posterior tibial flap. Ann Plast Surg 1990; 24: 318-27
  • 12 Koshima I, Soeda S. Free posterior tibial perforator-based flaps. Ann Plast Surg 1991; 26: 284-8
  • 13 Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A. The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 1992; 90: 643-9
  • 14 Satoh K, Yoshikawa A, Hayashi M. Reverse-flow anterior tibial flap type III. Br J Plast Surg 1988; 41: 624-7
  • 15 Wee JT. Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap. Br J Plast Surg 1986; 39: 327-37
  • 16 Satoh K, Aoyama R, Onizuka T. Comparative study of reverse flow island flaps in the lower extremities - peroneal, anterior tibial, and posterior tibial island flaps in 25 patients. Ann Plast Surg 1993; 30: 48-56
  • 17 Koshima I, Yamamoto H, Moriguchi T, Kawada S, Ono Y. Combined anteroposterior tibial perforator-based flap with a vascularized deep peroneal nerve for repair of facial defect. Ann Plast Surg 1994; 33: 421-5
  • 18 Huber JF. The arterial network supplying the dorsum of the foot. Anat Rec 1941; 80: 373-91
  • 19 Koshima I, Itoh S, Nanba Y, Tsutsui T, Takahashi Y. Medial and lateral malleolar perforator flaps for repair of defects around the ankle. Ann Plast Surg 2003; 51: 579-83
  • 20 Le Nen D, Beal D, Person H, Lefevre C, Sénécail B. Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg. Surg Radiol Anat 1994; 16: 3-8
  • 21 Touam C, Rostoucher P, Bhatia A, Oberlin C. Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower one-fourth of the leg, the ankle, and the foot. Plast Reconstr Surg 2001; 107: 383-92
  • 22 Lee YH, Rah SK, Choi SJ, Chung MS, Baek GH. Distally based lateral supramalleolar adipofascial flap for reconstruction of the dorsum of the foot and ankle. Plast Reconstr Surg 2004; 114: 1478-85
  • 23 Kilinc H, Bilen BT, Arslan A. A novel flap to repair medial and lateral malleolar defects: Anterior tibial artery perforator-based adipofascial flap. Ann Plast Surg 2006; 57: 396-401
  • 24 Demirtas Y, Ayhan S, Sariguney Y, Findikcioglu F, Cukurluoglu O, Latifoglu O. et al. Distally based lateral and medial leg adipofascial flaps: Need for caution with old, diabetic patients. Plast Reconstr Surg 2006; 117: 272-6
  • 25 Gilbert BJ, Horst F, Nunley JA. Potential donor rotational bone grafts using vascular territories in the foot and ankle. J Bone Joint Surg Am 2004; 86-A: 1857-73