An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps.
In the 1990s, skin island flaps supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, were introduced. Flaps supplied by the superficial peroneal nerve accessory artery (SPNAA), however, are still not commonly used. The aim of this study is to understand the anatomic structure of the SPNAA and its perforators in the anterior intermuscular septum and to use SPNAA perforator flaps in the clinic. We dissected 16 cadavers and assessed the location and number of the SPNAA, its perforators, and the septocutaneous perforators originating from the anterior tibial artery. A SPNAA perforator flap was applied to 12 patients, the free flap was applied to 11 patients, and the pedicled flap was applied to 1 patient. SPNAA varied from 7 to 16 cm in length, with an average of 4.5 perforators to supply the lateral aspect. An average of 3.13 septocutaneous perforators originated from the anterior tibial artery. The mean size of the SPNAA perforator flaps was 65.5 cm. The complete follow-up period was 3-20 months. Although 1 flap was lost as a result of arterial thrombosis, the procedure was successful in the remaining 11 patients. In addition, reduced flap thickness made them more esthetically appealing. SPNAA perforator flaps could be an excellent alternative to perforator flaps that use the lower leg as a donor site.
Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Republic of Korea.
Jun Sik
JS
Kim
Dae Gu
DG
Son
Tae Hyun
TH
Choi
Nam Gyun
NG
Kim
Kyung Suk
KS
Lee
Ki Hwan
KH
Han
Jun Hyung
JH
Kim
Sang-Il
SI
Lee
Dawon
D
Kang
D000328:Adult; D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D005260:Female; D016523:Foot Ulcer / Q000601:surgery; D006225:Hand / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery; D006365:Heel / Q000293:injuries / Q000601:surgery; D006801:Humans; D007866:Leg / Q000601:surgery; D007869:Leg Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve / Q000033:anatomy & histology*; D012883:Skin Ulcer / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D014950:Wounds, Penetrating / Q000601:surgery