Cutaneous perforators of the peroneal artery: Cadaveric study with implications in the design of the osteocutaneous free fibular flap

Abstract

Bilateral dissection of 15 formalin embalmed cadaver legs was performed in order to study the anatomic pattern of the peroneal artery (PA) and its cutaneous perforating vessels (CB). The total number of CB from the PA was 125 or an average of 4.17 branches per leg. CB were distributed in the superoinferior axis between 18.25 and 84.25% of the length of the fibula and their average length was 5 +/- 1.8 cm. 86/125 (68.8%) of the CB were classified as myocutaneous branches (MC) that penetrated muscle before reaching the skin, whereas 39/125 (31.2%) were septocutaneous branches (SC) that passed through the intermuscular septum. The mean distance between the posterior border of the fibula and the site where the perforators emerged was 1.88 +/- 0.79 cm for the SC and 1.21 +/- 0.87 cm for the MC. These anatomic findings should encourage the surgeon to design the skin paddle in the boundary between the middle and the distal third of the fibular length about 2 cm behind the posterior fibular border on the posterolateral leg, where the number of CB is maximal.

A Systematic Review and Pooled Analysis of Peroneal Artery Perforators for Fibula Osteocutaneous and Perforator Flaps

“…In a similar study, Papadimas et al evaluated 30 cadaveric legs and identified a total of 125 cutaneous perforating vessels, with an average of 4.17 branches per leg. 11 The authors went on to conclude that the highest density of perforators was in the 0.6 to 0.7 interval (mean fibular length, 37 cm) and that, based on this, a fibular skin paddle would be best centered at the boundary between the middle and distal thirds of the fibula. Cho et al verified these cadaveric results in the clinical setting by recording the perforators in 24 patients undergoing free fibula osteocutaneous transfer for femoral head osteonecrosis.…”

Lateral lower leg perforator flaps: An anatomical study to localize and classify lateral lower leg perforators

“…Concerning the lower leg, previous studies have mostly focused on perforators originating from a single source vessel . Peroneal artery perforators have been extensively described resulting in further refinements of the fibula osteocutaneous flap .…”

“…Papadimas et al found an average of 4.17 ± 0.9 peroneal artery perforators per leg. Perforators were distributed in the supero‐inferior axis between 18.25 and 84.25% of the length of the fibula . Their average length was 5 ± 1.8 cm.…”

“…Several studies on cutaneous vascularization of the lateral lower leg are based on the use of the fibula osteocutaneous flap . Other studies focus on perforators originating from a single source vessel, or on the complete integument of the lower leg . However, these studies lack comprehensive data on perforator characteristics (e.g., length, diameter, course, and vascular origin) or proper definition of the investigated region.…”

Regarding the vascular anatomy of muscles with a special focus on the gracilis muscle

“…The recent years, studies in clinical anatomy have produced valuable information on specific vascularization of the anatomical structures used in these flaps (Saadeh et al, 1998;Fróes et al, 1999;Traxler et al, 1999;Tao et al, 2000;Halim and Wan, 2004;Macchi et al, 2008Macchi et al, , 2009Rozen et al, 2008Rozen et al, , 2009Rozen et al, , 2010Rozen et al, , 2011Ger, 2009;Ma et al, 2009;Papadimas et al, 2009;Beer and Manestar, 2010;Piquilloud et al, 2011;Janus et al, 2012).…”