A study of the perforating arteries of the leg derived from the anterior tibial, posterior tibial and peroneal arteries

Tapadar, Arunabha; Palit, Sukanya; Kundu, Rajib; Sarkar, Aniruddha; Banerjee, Anirban

doi:10.1016/j.jasi.2014.04.003

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Most peroneal perforators are situated 13 to 18 cm above the lateral malleolus, emerging from the septum of the flexor hallucis longus and the peroneus brevis muscles. The distal perforators from the popliteal artery emerge approximately 5 cm proximal to the lateral malleolus 4,12,15 . Chaput et al 2 described two locations of perforators originating from the medial sural artery, which branches off the popliteal artery.…”

Section: Discussionmentioning

confidence: 99%

“…The distal perforators from the AP emerge approximately 5 cm proximal to the lateral malleolus. 4 11 14 Chaput et al 2 described two locations of perforators originating from the MSA, which branches off the AP. The first perforator is approximately 8 cm from the midpoint of the popliteal crease, whereas the second perforator is around 12 to 15 cm from the popliteal crease.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, preoperative perforator mapping is necessary to ensure the safety and applicability of these flaps. Many authors have described the distribution of perforators originating from the popliteal artery (AP), the medial sural artery (MSA), the anterior tibial artery (ATA), the posterior tibial artery (ATP), and the fibular artery (AF), as well as their angiosomes [12][13][14] . The aim of this study was to confirm the most stable perforators in the lower leg by using color-coded duplex sonography (CCDS) devices, thermal imaging cameras (TIC), handheld acoustic Doppler (HHAD) devices, and computed tomography angiography (CTA), and to assess the changes in these perforators after digital subtraction angiography (DSA) and percutaneous transluminal angioplasty (PTA) interventions.…”

Section: Introductionmentioning

confidence: 99%

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Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Lovětínská,

Sukop,

Sulženko

et al. 2024

J Reconstr Microsurg Open

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Background: Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA). Methods: 10 patients with lower extremity defects requiring DSA, had undergone examinations applying standard methods. The localization of 40 stable perforators originating from three main arteries in crura was performed before and after angiography. Where stenoses or occlusions were observed, percutaneous transluminal angioplasty (PTA) was conducted, and changes in the perforator velocities following reperfusion were measured. Results: Angiographic abnormalities were observed in all cases. Prior to PTA, acoustic Dopplers detected 37 out of 40 perforators (90%), while color-coded sonography detected 35 out of 40 perforators (87.5%). After PTA, these numbers increased to 38 out of 40 (95%) and 37 out of 40 (92.5%) respectively. The mean flow characteristics included the peak systolic velocities (PSV) of 21.9 and 27.2, end-diastolic velocities (EDV) of 9.4 and 11.4 respectively. Post-intervention 16 micro vessels exhibited enlarged lumen diameters ranging from 1 to 3 mm, resulting in increased perfusion values for PSV in 85.2% (21.9/27.2) and EDV in 88.2% (9.4/11.4) of the patients. However, 2 perforators showed decreases in flow velocity after PTA. Conclusion: In most patients with chronic lower leg wounds and other comorbidities, adequate perforators for reconstruction can be identified by using conventional methods. PTA interventions positively impact blood flow in perforators, although they are not necessarily required prior to reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Lovětínská,

Sukop,

Sulženko

et al. 2024

J Reconstr Microsurg Open

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“…In the cadaveric study by Tapadar et al . [ 18 ] 20 legs were dissected. Perforators arising from the anterior tibial artery were found to be clustered in the upper and middle third of the leg, the majority of perforators from the posterior tibia artery were in the middle one-third of the leg while the perforators from the peroneal artery were distributed all along the posterior intermuscular septa.…”

Section: Discussionmentioning

confidence: 99%

Thermographic mapping of arterial perforators in the leg

Obadan,

Michael,

Iyun

et al. 2023

J West Afr Coll Surg

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Background: Preoperative localisation of perforators aids in easy intraoperative dissection. Infrared thermography is a simple, safe, and effective tool with a short learning curve that is useful in identifying perforators. It has been found to have a high concordance rate when compared with computed tomography angiography and is useful in identifying arterial perforators in the leg. Objectives: To create a thermographic map of arterial perforators in the leg and to determine the correlation between the number of perforators identified and the length of the leg. Materials and Methods: This was a cross-sectional study. The length of the leg was measured and the location of perforators corresponding to the distribution of the anterior tibial, posterior tibial, and peroneal arteries was identified using thermography. The mean number of perforators corresponding to the different surfaces of the leg was noted, this was then correlated with the length of the leg using the Pearson correlation coefficient. Results: Using thermography, perforators were identified along a line drawn from the medial malleolus to the medial tibia plateau and from the lateral malleolus to the head of the fibula and within 2 cm of these lines. More perforators were found in the middle third of the leg and there was no significant correlation between the number of perforators and the length of the leg. Conclusion: A useful surface marking to aid the identification of perforators in the leg using infrared thermography was found. There was no significant correlation between the length of the leg and the number of perforators.

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“…It passes between the two heads of the tibialis posterior and enters the extensor compartment, crossing the interosseous membrane. Along its course, the ATA gives out 3–4 perforators on average, both musculocutaneous and septocutaneous [ 7 , 8 ]. Morrison and Shen [ 9 ] demonstrated that in most cases the main perforator is a septocutaneous vessel that originates within 7 cm from the fibular head and penetrates the deep fascia through the anterior intermuscular septum between the extensor digitorum longus and peroneus muscles.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Muscle Exercise on Perforators Flow: A Prospective Cohort Study

et al. 2020

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Background and objectives: The metabolic response after exercise causes a significant increase in the muscle blood flow. While these effects are demonstrated for intra-muscular vessels, there is no evidence about the inter-muscular vessels, such as the septocutaneous perforators supplying the skin after they branch out from the deep source artery. The aim of our prospective study was to quantify the changes in the anterior tibial artery perforators arterial blood flow after mild isotonic exercise in a young and healthy population. Material and Methods: We performed a prospective analysis of 34 patients who were admitted to the Plastic Surgery Department from December 2019 to April 2020. Flow velocities of two previously identified anterior tibial artery perforators were recorded both before and after 10 complete flexion-extensions of the foot. The time to revert to basal flow was measured. We further classified the overmentioned patients based on their level of physical activity. Results: We registered a significant increase in systolic, diastolic and mean blood flow velocities both in proximal and distal anterior tibial artery perforators after exercise. Fitter patients exhibited a higher increase in proximal leg perforators than those who did less than three aerobic workouts a week. The time to return to basal flow ranged from 60 to 90 s. Conclusions: This was the first study to describe the effect of muscular activity on perforators blood flow. Even mild exercise significantly increases the perforator flow. Waiting at least two minutes at rest before performing the Doppler study, thus avoiding involved muscle activation, can notably improve the reliability of the pre-operative planning.

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A study of the perforating arteries of the leg derived from the anterior tibial, posterior tibial and peroneal arteries

Cited by 5 publications

References 13 publications

Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Stable Arterial Perforators Mapping in Lower Leg Using Color-Coded Doppler Sonography, Acoustic Doppler, and Thermal Imaging Camera in Patients Undergoing Digital Subtraction Angiography

Thermographic mapping of arterial perforators in the leg

The Effect of Muscle Exercise on Perforators Flow: A Prospective Cohort Study

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