The Clinical Anatomy And Application Research On The Distribution Characteristics Of The Posterior Tibial Artery Perforators

1 Background There are short of the detailed anatomy studies on the distribution characteristics of the posterior tibial artery perforators and their secondary branches in clinical practice.The perforator flap and pedicle tissue flaps based on the perforator are studied more,but bilobed skin flap based on the perforator,chimeric flap based on the perforator,and cross-bridge tissue flaps based on the perforator are studied less in clinical practice.2 Objective2.1 Chapter?:The clinical anatomic study on the distribution characteristics of the posterior tibial artery perforators To research the distribution characteristics of the posterior tibial artery perforators and their secondary branches to provide the anatomic basis for the clinical application of a series of tissue flaps based on the posterior tibial artery perforators.2.2 Chapter ? :The clinical application research on the distribution characteristics of the posterior tibial artery perforators To investigate the clinical application effect of a series of tissue flaps based on the posterior tibial artery perforators for reconstruction of the different kinds of tissue defects of the wound,in order to promote the series of tissue flaps to be widely used in clinic.3 Methods3.1 Chapter?From December,2013 to December,2015,10 patients whose condition was relatively stable were selected in clinical practice and needed to be cut out the large flap based on the posterior tibial artery from the medial crus.Posterior tibial artery perforators and their secondary branches were fully revealed and their number,type,diameter,length,distribution characteristics etc were observed and recorded in the process of cutting out the leg medial skin flap.At the same time,the test data were analyzed by the statistical software.3.2 Chapter?The legs of the patients accepted the digital subtraction angiography or color doppler flow imaging?CDFI?to find the different kinds of perforators from the posterior tibial artery,then Color doppler flow imaging?CDFI?was used to track branches and direction of the larger perforators in the upper middle section of the posterior tibial artery.According to the characteristics of the different kinds of the soft tissue defect wound,the tissue flap based on the perforator selected was designed and cut out.A total of 24 patients in the study,according to the different types of perforators,results of clinical application: 5 cases of the bilobed skin flap based on the perforator of the posterior tibial artery,17 cases of the chimeric flap based on the perforator of the posterior tibial artery,2 cases of the cross-bridge tissue flaps based on the perforator of the contralateral posterior tibial artery.4 Results4.1 Chapter?In 10 patients,a total of 52 posterior tibial artery perforators were identified and their secondary branches could be divided into four types.The perforators from the proximal part of the posterior tibial artery were less,their length were the longest and their diameters were the thickest.The perforators from the middle part of the posterior tibial artery were more,their length were the longer and their diameters were the thicker.The perforators from the distal part of the posterior tibial artery were more,their length were the shortest and their diameters were the smallest.4.2 Chapter?24 patients of the series of tissue flaps based on the perforators of the posterior tibial artery in the study were survived,the skin graft of the flap donor area developed well,and all the wounds healed by 1^stintention.Followed-up for 3²4 months after operation,shapes,color,texture,elasticity of the skin flaps were normal.X-ray evaluations performed at postoperative following-up,bone fracture healed good and fracture line disappeared after 3¹2 months.12 cases of all flaps were flat with the surrounding tissue,but they were flat with the surrounding tissue on the secondary revision,and appearance of the others were satisfactory.According to the related evaluation criteria made by the Chinese Medical Association,the results of 15 cases of hand trauma patients were excellent in 11 cases,good in 3 cases,may in 1 case.Nine cases of lower foot and leg trauma patients could walk with bearing weight without pain.5 Conclusions5.1 Chapter?The perforators from the proximal and middle part of the posterior tibial artery are suitable for design and harvest of free or pedicle tissue flaps with the perforator pedicle.The perforators from the distal part of the posterior tibial artery are suitable for design and harvest of the pedicle tissue flaps.The secondary branches of the posterior tibial artery perforators are divided into four types,and a series of tissue flaps based on them are cut out,such as perforator flap,bilobed skin flap based on the perforator of the posterior tibial artery,chimeric flap based on the perforator of the posterior tibial artery,cross-bridge tissue flaps based on the perforator of the contralateral posterior tibial artery.5.2 Chapter?It is feasible to design and cut out the bilobed skin flap based on the perforator,chimeric flap based on the perforator,and cross-bridge tissue flaps based on the perforator.Three types of tissue flap don't sacrifice known vessels with minimal donor site morbidity,and the district restores.They are ideal methods to repair the tissue defect.