| [Objective] To sum up the origins, courses, distribution and anastomosis of the superficial peroneal nerve and its nutrifying vessels. Especially study on the vascular anastomosis between the superficial peroneal artery and the ascending branch of the lowest perforating branch of the peroneal artery. Therefore, to confirm whether the vascular anastomosis of these two arteries can meet the blood supply need of a reversal flow axial flap, and according the obtained theory on the reversal flow axial island flap, we will design and apply the superficial peroneal nerve nutrifying vessels reversal flow axial island flap pedicled with the lowest perforating branch of the peroneal artery. [Methods] Ten fresh lower extremities of human cadavers were injected with red latex, and then microsurgical anatomy and radiograph were made to sum up the origins, courses, distribution and anastomosis of the superficial peroneal nerve and its nutrifying vessels. Especially study on the vascular anastomosis between the superficial peroneal artery and the ascending branch of the lowest perforating branch of the peroneal artery. [Results] 1. The superficial peroneal nerve origins from the common peroneal nerve at the fibular neck. The diameter of the superficial peroneal nerve is 2.6±0.3mm at the original site, and its course were separated into three segments. On the 1/3 proximal part of the leg, the superficial peroneal nerve goes along the deep side of the anterolateral intermuscular septum; on the middle 1/3 part of the leg, the nerve goes under the deep fascia; on the lower 1/3 part of the leg, the major stem and its branches perforates through the deep fascia, and moves to the inner side between the subcutaneous tissue. Its major stem cross over the ankle joints separated into two terminal branches: inner dorsal foot and medial cutaneous nerve. There are some reversal branches along the course of the superficial peroneal nerve. The major two are anteromedial and posterolateral reversal branches. These two branches major distribute around the middle and lower 1/3 part of the legs, middle and inner dorsal parts of the feet. 2. The nutrifying vessels of the superficial peroneal nerve mainly come from the superficial peroneal artery, and its appearance rate is 100%. At the site 4.7±2.5cm lower form the fibular head, The nutrifying vessel origins from the anterior tibial artery, and its original diameter is 0.9±0.25mm. two veins are escorting this artery, and their diameter are 1.3±03mm. The nutrient artery moves downwards from the origin, and at site 10.1±0.32 cm lower form the fibular head, it escorts the superficial peroneal nerve. During the course moving downward, the superficial peroneal artery reaches out directly to the nerve in a T form which either goes into the trunk of the nerve or goes along with the nerve, eventually the adjacent blood vessel forms into ablood net work along the axis of the nerve. 3. the anastomosis between the superficial peroneal artery and the intramuscularly septal perforating artery (2.1±0.62) of the anterior tibial artery is abundant on the upper 1/3 part of the leg; This anastomosis is also ample on the middle-lower part. The anastomosis between the superficial peroneal artery and the terminal ascending branch of the tibial artery is abundant, stable on the lower 1/3 part of the leg. The above anastomosis are obvious and affluent both in the surface of the deep fascia and in surroundings of the cutaneous nerves, which forms into the net work along the axis direction of the nerve. Besides the nourishing branches to the nerves, there are also nourishing branches to the fiscal and skin. [Conclusion] 1. In the present study, Ten fresh lower extremities of human cadavers were injected with red latex, and then microsurgical anatomy and radiograph were made to sum up the origins, courses, distribution and anastomosis of the superficial peroneal nerve and its nutrifying vessels. the anastomosis between the superficial peroneal artery and the intermuscular septal perforating artery of the anterior tibial artery is abundant on the upper 1/3 part of the leg; these anastomosis is also ample on the middle-lower part. The anastomosis between the superficial peroneal artery and the terminal ascending branch of the tibial artery is abundant, stable on the lower 1/3 part of the leg. The above anastomosis are obvious and affluent both in the surface of thedeep fascia and in surroundings of the cutaneous nerves, which forms into the network along the axis direction of the nerve. Besides the nourishing branches to the nerves, there are also nourishing branches to the fiscal and skin. 2. The anastomosis between the superficial peroneal artery and the terminal ascending branch of the tibial artery is abundant, stable on the lower 1/3 part of the leg. These anastomosis belongs to the typeⅡreversal flow anastomosis. Therefore the kind of flap has the anatomic basis of the reversal blood flow supplies. 3. the major problem of this flap is the obstruction of the circumfluence of the vein, especially in the 72 hours after the surgery. This is mainly because the accomplishment of the circumfluence of the vein is achieved by the anastomosis between the two axial veins, which has a longer circulation distance than the original veins. The obstruction of the circumfluence of the vein often happens if the blood pedicel to the flap is cut too long. For this reason, we should avoid using long blood pedicel flap during the surgery, in the meantime; we should attach 2-3cm wide skin bridge or fascia tissues to the blood pedicel, which will assist the circumfluence of the vein. In the early stage after the surgery, especially in the 72 hours after surgery, we should take a close look to the circulation of the flap. A immediate treatment should be given once the veins collapse. 4. Based on the above anatomic research, we designed the nutrifying vessel reversal flow axial island flap pedicled with the...
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