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

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.

One Stage versus Two Stages Distally Based Reverse Sural Flap for Leg and Foot Reconstruction: A Meta-Analysis Study

“…The lateral malleolar artery and the lateral calcaneal artery could serve as the main perforators for a very low flap pivot point. The pivot point should be set at approximately 7 to 8.5 cm proximal to the lateral malleolus to retain all major perforators [5] . The greater mobility and versatility of the reverse-flow sural flap, in addition to sparing important arteries, had shown increasing success rates and few complications [1] .…”