| Objective:With the development of microsurgical technique, vascular anastomosis diameter demands more and more small, perforators flap was widely used in clinic. Due to the resources limitation and the clinical repair plastic surgeon, one-third of the leg and foot injuries after the reconstruction is more difficult. It is difficult to design local flaps of adjacent tissue. Most researchers believe that the reparation for one-third of the leg and foot injuries who take a longer using the lower part of peroneal artery perforators fascia flap may be safety.Cutting long axis of the flap harvest time by flap on the long interval of the lateral crus muscle, blood vessels between the peroneal artery perforators chain on the axis of the flap, to form a shaft up blood flow, so that we can guarantee the safety of the flap, otherwise unworkable, posterior lateral crus skin blood supply mainly comes from the peroneal artery perforators, only understand peroneal artery perforators and the vascular anatomy construction to guide the clinical understanding and application of peroneal perforators flap has important significance. The current clinical application of perforator’s flap, to change a single branch, the source of vascular anatomy to construct knowledge, being a single building replaced perforator’s anatomy. Perforators flap after a lot of anatomical study and clinical application, the purpose of this study is the true perforators of the peroneal artery, and through the anatomical study, observe whether there is a chain of vascular anastomosis between the adjacent perforators, and to guide clinical obtain larger calf posterolateral perforators flap to provide the anatomical basis.Methods:Through the microscopic gross anatomy, CT scan, blood vessel casting anatomy research techniques, observation and measurement of perforators of the peroneal artery distribution range, and the blood vessels chain between the perforators. Fresh adult lower limb specimens from 17 side (female 2 side, the male side of 15) age is unknown, broken forme the hip joint, skin appearance there is no history of trauma and surgery; the2 side of the 17 side specimens for making cast specimens; 13 specimens vascular perfusion red latex, fine dissection under the microscope, carefully remove adipose tissue in superficial fascia, fully display perforator and the blood vessels chain between the perforator, observed the blood vascular chain form, as far as possible, show the blood vessels links between perforators, and to track anatomy each vascular branches; Two side specimens of vascular perfusion containing oxide bismuth was red latex,the first step was to CT scan to scan the perforators and the vascular chain between perforator,and fine surgery was performed under the microscopic anatomy. Division 15 lower leg specimens into 7 average ranges from the highest point of fibular head to edge of external ankle, then measure the length of the fibula, length of the fibula, peroneal artery diameter and the length of perforating branch pedicle. The area which arteria peroneal perforating branches distribute. And the perforators located in interval due to the next interval. Considerating clinical practicability and the possible error in measurement, we include the perforating branches whose diameter≥0.5mm into our statistical analysis.Results:1.The results of the peroneal artery perforators measurement:15 side specimens, the total number of the perforators from peroneal artery is 69, each side is 3～7 branches, the average (4.25± 1.56) branches, and its diameter is (0.89±0.31, 0.51-1.61)mm in deep fascia, the length of the fibula (34.78± 17.78 31.4～34.78) cm; From the partition to see the peroneal artery perforators most concentrated area in 3,4, 5 and 6, partition,the perforators number is 15,18,13 and 16 branches, the percentage of the total number of perforators respectively are 21.74%,26.09%,18.84% and 21.74%; in each interval the perforators of peroneal artery diameter measurement, according to the results of the size of the diameter of all conform to the requirements of the fiber surgical anastomosis. Pedicle length measuring situation indicates 1 and 7 interval pedicle length is shorter, respectively (3.01±0.772.46～3.56) cm and 3.47 cm; 2,3,4,5 and 6 interval pedicle long did not change significantly more balanced, respectively (5.37±1.59 4.38～6.99) cm、(6.43±1.14 4.97～6.42) cm、(7.85±0.78 6.12～5.43)cm; (5.45±0.65 4.58～6.04)cm and (4.15±0.23 3.17～5.32)cm; Concerning the course of arteria peronea perforating branches, perforating branches of Nearly period of peroneal artery mostly go through soleus, these perforators through after the issue of the peroneal artery to down line in soleus, with long peroneal muscle and soleus muscle through the gap.Through the long hallux flexor perforators, starting in intramuscular go line length is (1.59±0.57) cm, eventually the lateralis clearance after wear out and see more in region 4,5; perforating branches in region 6 go through intermuscular space.2. Found microscopically anatomic observation:by observing the perforators came into being after the lateral crus of the peroneal artery vascular chain in row direction and lateral sural cutaneous nerve, peroneal artery usually long axis, the long axis of the fibula.Blood vessels and the chain is to coincide with the nutrient vessels of the lateral sural cutaneous nerve, from the perspective of the position of vascular distribution chain wear between the formation of the peroneal artery blood vessels the position of the chain is most concentrated in the calf part 3,4,5,6 region (10～30 cm), external ankle above the 6 area has a constant wear, its diameter is (0.91±0.35) mm, peroneal artery perforators along the fibula after trailing lateralis interval after wearing out, is not directly into the superficial fascia, but under the deep fascia or deep fascia oblique line after a distance, into the superficial fascia branches, wear a point to its perforators of branch length is (1.39±0.75 0.83～2.15) cm.CT scans and vascular casting skin peroneal artery branch chain observation:peroneal artery are observed by MIP images in distribution, the lateral crus of perforators from peroneal artery perforators position on (3～6) area (10～30)cm range, can well see the lower part of peroneal artery in six areas of constant wear.VRT color images show that the lateral crus vascular anastomosis between the wear and wear a chain of blood vessels and blood vessels, wearing dense vascular anastomosis between the blood vessels like hair, and the indirect connection complex interconnected into longitudinal lines of skin branched chain, and the closer the skin blood vessels, high density shadow show more concentrated. Vascular cast peroneal artery skin branched chain observation:peroneal artery perforators dense vascular anastomosis between blood vessels, complex interconnected, skin perforators of branch chain focused in region (3～6).Conclusions:1. The peroneal artery perforators main distribution of the lateral crus between 3～6 area, perforators of the peroneal artery diameter and long could satisfy the vascular anastomosis of fiber surgery.2. The application of perforators this combination between the peroneal artery blood vessels chain could design transposition flap, department but ingenious use of extended wear vascular anastomosis between the teams.3. The long axis of the perforators flap base of the peroneal artery should as far as possible consistent with the long axis of peroneal artery, appropriate application of transverse skin branched chain, strengthen the width of the flap, rib has to get a larger perforators flap. |
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