The Anatomical Study Of The Reversed Peroneus Longus And Brevis Combined With The Musculocutaneous Flap

[Objectives] To study the blood supply of the lateral crus, long peroneal muscle and short peroneal muscle with the technology of the traditional specimens of anato my,modern vascular perfusion and 3-D reconstruction.And to discuss the characteristics of the blood s u p p l y o f r e v e r s e d m u s c u l u s p e r o n e u s b r e v i s a n d l o n g u s musculo-cutaneous flap pedicled with the cutaneous arteries.Joint muscle flap can be designed to repair the calf part and ankle,and then apply it to the clinical to simplify the procedure of the surgery and improve the treatment effects. [Materials and Methods]1.20 fresh lower extremity specimens were used with arteries injected with red lactoprene.The musculus peroneus brevis and longus were dissected and the originations, courses, branches and the distributions of the peroneal arteries were studied. 2.Another 2 fresh lower extremity specimens with the arteries were injected with plumbous oxide and lactoprene, then the specimens were CT scanned and the bones and arteries were 3D-reconstructed and studied. [Results]1. The proportion of peroneal artery originated from posterior tibial artery was 90%,and originated from popliteal artery and pretibial artery were 5% respectively.The diameter of the originate peroneal artery was(3.62±0.88)mm, the artery gave off many muscular branches to the soleus muscle, long flexor muscle of great toe, musculus peroneus brevis and longus and the skin. 2. The branch originated from peroneal artery was(5.32±1.13),which went through the gap of soleus and peroneus longus with the diameter of(0.72±0.03)mm,supplied he blood to lateral leg skin.The vascular pedicle that the peroneal artery went through could free for(3.61±1.25) cm,the front and back branch appeared after each cutaneous artery went through the spatium intermusculare and anastomosed together.3. The terminal branch of peroneal artery got through the interosseous membrane between the tibia and fibula,and run in the intermuscular septum of the extensor digitorum longus and the peroneus brevis.The outer diameter of artery was(1.12±0.53)mm,and divided into ascending branch and the desecnding branch.The peroneal artery gave off branches from connection between ankle(6.32±2.81)cm to relate to the posterior tibial artery,outer diameter(1.12+0.25) mm, after tibial periosteum level inward andposterior tibial artery phase transport.4. The peroneus longus orinated originated from the lateral part at the top of fibula,its top half blood supply came from the branch of anterior tibial artery,its bottom half blood supply came from the branch of peroneal artery, the tendon came into the medial of the foot and terminated in the inside of the wedge 1 metatarsal bone and lateral below.5. The peroneus brevis originated from facies lateralis fibulae and covered by peroneus longus orinated.The average distance from muscle and Tendon junction to lateral malleolus was(1.41±1.05)cm,With short tendon around behind the external ankle forward, and terminated on the bottom of the fifth metatarsal.On the top of peroneus brevis muscle belly,there was a relatively thick superficial peroneal artery,which originated from the anterior tibial artery,and got through the i n t e r o s s e o u s m e m b r a n e t o t h e p e r o n e u s l o n g u s a n d t h e leg anterolateral group muscles,diameter(1.72±0.65)mm,and it provided nutrition to peroneus brevis,superficial peroneal nerve and skin of front leg.6. The superficial peroneal nerve in the neck of fibula originated from nervus peroneus communis,and got through the deep fascia in two methods of the trunk and branch,up to the acrotarsium,and gave off the medial and lateral branch.7. The outer diameter of superficial peroneal artery at the initial site was(1.92±0.45)mm,and gave off 2-3 branch of muscle to peroneus longus in the range of 7-19 cm under the fibular head.the outer diameter of the artery was(0.45±0.23)mm,and 1-2 branches of fascia cutaneous got through the skin.[Conclusions] This study put forward by gross anatomy and 3D-reconstruction as well as in the preliminary clinical application, design with phil shallow artery pedicled, cut in retrograde peroneal long, short joint muscle myocutaneous flap, lower leg and foot tissue defect repair is feasible.