Download PDF
J Reconstr Microsurg 2003; 19(3): 157-162
DOI: 10.1055/s-2003-39828
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Vasculature of the Peroneal Artery: An Anatomic Study Focused on the Perforator Vessels

Christoph Heitmann1 , Fahar N. Khan2 , L. Scott Levin2
  • 1Department of Plastic, Reconstructive and Hand Surgery, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany
  • 2Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina
Further Information

Publication History

Publication Date:
13 June 2003 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Based on the dissection of 20 fresh cadaver legs, the authors have further defined the vascular anatomy of the peroneal artery and its cutaneous perforator vessels. They identified a total of 95 cutaneous perforators of the peroneal artery greater then 0.3 mm in 20 legs. The average number of cutaneous perforators was 4.8 (range: three to seven) per leg. The cutaneous perforators were either musculocutaneous (34 percent) or septocutaneous (66 percent). The musculocutaneous perforators were found predominantly in the upper two-thirds of the lower leg; the septocutaneous perforators were located in the lower two-thirds of the leg. The external diameter of the cutaneous perforators at the posterior border of the fibula was 0.6 (range: 0.3 to 1.5) mm. The blood supply of the proximal fibula epiphysis and fibula head was found not to be in the vascular territory of the peroneal artery. These results are the basis of the established osteoseptocutaneous fibula transfer, the peroneal fasciocutaneous free flap, and the double-paddle peroneal tissue transfer that all require dissection of highly vascularized tissue adjacent to the fibula, in order to reach the peroneal vessels. These constant anatomic findings should encourage the surgeon to harvest skin flaps just to the level of the posterior border of the fibula, thereby creating perforator flaps based on the peroneal system.

KEYWORDS

Peroneal artery vasculature - perforator vessels - perforator flaps

REFERENCES

  • 1 Blondeel P N. Personal communication to the authors in: Debate: “The consensus on perforator flap terminology: preliminary definitions.” International Course on Perforator Flaps 2001, Gent, Belgium. 
  • 2 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg . 1994;  32 32
    Search in Google Scholar
  • 3 Allen R J, Tucker C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconstr Surg . 1995;  95 1207
    CrossrefPubMedSearch in Google Scholar
  • 4 Angrigianni C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle.  Plast Reconstr Surg . 1995;  96 1608
    CrossrefPubMedSearch in Google Scholar
  • 5 Safak T, Akyuerek M. Free transfer of the radial forearm flap with preservation of the radial artery.  Ann Plast Surg . 2000;  45 97
    PubMedSearch in Google Scholar
  • 6 Koshima I, Soeda S. Free posterior tibial perforator-based flaps.  Ann Plast Surg . 1991;  26 284
    CrossrefPubMedSearch in Google Scholar
  • 7 Wei F C, Jain V, Celic N. et al . Have we found an ideal soft tissue flap?.  <~>An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg . 2002;  109 2219
    Search in Google Scholar
  • 8 Jupiter J B, Bour C J, May J W. The reconstruction of defects in the femoral shaft with vascularized transfers of fibula bone.  J Bone Joint Surg . 1987;  69A 365
    PubMedSearch in Google Scholar
  • 9 Minami A, Kasashima T, Iwasaki N. Vascularized fibula grafts.  J Bone Joint Surg . 2000;  82B 1022
    PubMedSearch in Google Scholar
  • 10 Santamaria E, Wei F C, Chen H. Fibula osteoseptocutaneous flap for reconstruction of osteoradionecrosis of the mandible.  Plast Reconstr Surg . 1998;  101 921
    CrossrefPubMedSearch in Google Scholar
  • 11 Carr A J, Macdonald D A, Waterhouse N. The blood supply of the osteoseptocutaneous free fibula graft.  J Bone Joint Surg . 1988;  70B 319
    PubMedSearch in Google Scholar
  • 12 Yoshimura M, Shimamura K, Yoshinobu I. Free vascularized fibula transplant. A new method for monitoring circulation of the grafted fibula.  J Bone Joint Surg . 1983;  65A 1295
    PubMedSearch in Google Scholar
  • 13 Beppu M, Hanel D P, Johnston G HF. The osteocutaneous fibula flap: an anatomic study.  J Reconstr Microsurg . 1992;  8 215
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Wei F C, Chen F, Chuang C, Noordhoff M. Fibular osteoseptocutaneous flap: anatomic study and clinical application.  Plast Reconstr Surg . 1986;  78 1991
    PubMedSearch in Google Scholar
  • 15 Chen Y L, Zheng B G, Zhu J M. Microsurgical anatomy of the lateral skin flap of the leg.  Ann Plast Surg . 1985;  15 313
    CrossrefPubMedSearch in Google Scholar
  • 16 Nakashima H, Araki Y, Nishikido E. Free peroneal flap for wide skin defects of the foot and palmar scar contracture of the hand.  J Reconstr Microsurg . 1987;  3 105
    PubMedSearch in Google Scholar
  • 17 Yoshimura M, Shimada T, Hosokawa M. The vasculature of the peroneal tissue transfer.  Plast Reconstr Surg . 1990;  85 917
    PubMedSearch in Google Scholar
  • 18 Carriquiry C, Aparecida C M, Vasconez L O. An anatomic study of the septocutaneous vessels of the leg.  Plast Reconstr Surg . 1985;  76 354
    CrossrefPubMedSearch in Google Scholar
  • 19 Yang K C, Leung J KW, Chen J S. Double paddle peroneal tissue transfer for oromandibular reconstruction.  Plast Reconstr Surg . 2000;  106 47
    CrossrefPubMedSearch in Google Scholar
  • 20 Saito H, Kimura Y, Tsuda G. Free peroneal skin flap for oropharyngeal reconstruction.  Scand J Plast Reconstr Hand Surg . 1999;  33 41
    PubMedSearch in Google Scholar
  • 21 Yoshimura M, Shimada T, Matsuda M. Double peroneal free flap for multiple skin defects of the hand.  Br J Plast Surg . 1989;  42 715
    CrossrefPubMedSearch in Google Scholar
  • 22 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Paraumbilical perforator flap without deep inferior epigastric vessels.  Plast Reconstr Surg . 1998;  102 1052
    CrossrefPubMedSearch in Google Scholar
  • 23 Koshima I, Urushibara K, Inagawa K. Free medial plantar perforator flaps for resurfacing of finger and foot defects.  Plast Reconstr Surg . 2001;  107 1753
    CrossrefPubMedSearch in Google Scholar