Anatomical Study And Clinical Application Of The Terminal Posterior Perforator Of Peroneal Artery

Chapter ? Anatomical study and origin classification of the terminal posterior perforator of peroneal arteryObjectiveTo understand the anatomic characteristics of the terminal posterior perforator of peroneal artery and its communication with the deep vessels,and to provide anatomical basis for clinical and improved application.MethodsMicroanatomy was performed on 24 sides of the lower extremity specimens to observe the position,outer diameter,source and shape of the terminal posterior perforator of peroneal artery.If the source was secondary branch,marked it and observed its outgoing position,outer diameter and shape,and continued to explore the traffic relationship with the main peroneal artery,the anterior terminal perforator,the terminal branch,the posterior communicating arch,etc.All the data were analyzed by SPSS21.0.ResultsThe terminal posterior perforator of peroneal artery was directly from the main artery in 17 sides,which was distributed in the range of 3.8cm-7.8cm above the lateral malleolus tip,the external diameter was 1.36±0.38mm.The other 7 sides came from the secondary branch of the peroneal artery,which was distributed in the range of 8.4cm-15.4cm above the lateral malleolus tip,the external diameter was 1.69± 0.51mm;Four of them was communicated with the deep vessels at the posterior side of the lateral malleolus and formed the terminal branch to enter the posterior space of the lateral malleolus,and three of them had no communication relationship.ConclusionsThe position and shape of the terminal posterior perforator of peroneal artery are relatively unstable,which may originate from the main or secondary branches of the peroneal artery.To analyze the different traffic relationship between them and the deep blood vessels in the lateral malleolus area,and to preliminarily put forward the relevant classification(three types and six subtypes),to guide the clinical application and the flap transformation.Chapter ? Clinical application and transformation of the terminal posterior perforator flap of peroneal arteryObjectiveTo analyze the clinical effect of the terminal posterior perforator flap of peroneal artery to repair the skin defect of foot and ankle,and to implement relevant transformation applications which combine with anatomical classification of perforator.MethodsFrom March 2017 to August 2019,34 cases of skin defect of foot and ankle were repaired with the terminal posterior perforator flap of peroneal artery and related flap.Wound location:posterior calcaneus in 15 cases,lateral calcaneus in 7 cases,anterior malleolus in 5 cases,lateral malleolus in 4 cases,middle foot in 3 cases.The area of the defect ranged from 2.0cm × 1.5cm to 9.0cm × 8.0cm.The flap was cut from 4.0 cm×3.0cm to 15.0 cm × 9.0 cm.The skin flap and donor area were followed up and AOFAS ankle hindfoot scoring standard was used to evaluate the function.ResultsIn this group,19 cases were repaired with perforator propeller flap,and 3 cases of them were transformed and applied.15 cases were repaired with the perforator fasciocutaneous flap which carried sural nerve.Among them,31 flaps survived successfully,3 flaps had marginal necrosis.All the patients received 3 to 18 months postoperative follow-up.18 flaps were not overstaffed,13 flaps were slightly overstaffed and 3 flaps were overstaffed.32 cases recovered the protective sensation and 2 cases did not.The excellent and good rate of AOFAS was 85.2%.ConclusionsAccording to anatomical classification of perforator,it can be used to guide the cutting and clinical application of the terminal posterior perforator pedicled flap of peroneal artery.It can also be improved to further transform the application,expand the scope of repair,enrich the methods of repair,broaden the indications of operation,and further promote application.