title: Vascular anatomy and clinical application of anterolateral leg perforator flaps.
abstract: BACKGROUND
  There is a dearth of detailed published work on anterolateral leg perforators. The authors fully documented the vascular basis of the anterolateral leg perforator flap and report its use in reconstruction of distal extremities.
  
  
  METHODS
  Anterolateral leg perforators were investigated in 25 fresh cadavers and 10 casts of arteries. Fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using multidetector-row computed tomography and professional software. The origin, course, and distribution of the perforators in the anterolateral leg region were observed. Between March of 2008 and March of 2012, 15 free superficial peroneal artery perforator flaps were used for reconstruction of distal limbs. Flap size varied from 3.5 × 4.0 cm to 11 × 5 cm, with a uniform thickness of 3 mm.
  
  
  RESULTS
  There were 7 ± 3.0 perforators in the anterolateral leg. The average external diameter was 0.7 ± 0.2 mm. Each perforator supplied an average area of 33 ± 8.0 cm. Extensive anastomoses were found between the superficial peroneal artery perforators and multiple adjacent source arteries. All cases were repaired successfully without any complications. The clinical results were satisfactory after 3 to 12 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors.
  
  
  CONCLUSIONS
  The anterolateral leg perforator flaps have a consistent, reliable blood supply and good texture. The donor site not only supplies a thin skin flap but also provides the option of harvesting cross-boundary proximally or distally based perforator flaps that could be useful for repairing widespread traumatic soft-tissue defects.
authors.affiliation: Yiwu and Wenzhou, Zhejiang, People's Republic of China From the Department of Hand and Foot Surgery, Yiwu Central Hospital, and the Department of Anatomy, Wenzhou Medical College.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Yang
authors.forename: Genfu
authors.initials: G
authors.lastname: Zhang
authors.forename: Yangwu
authors.initials: Y
authors.lastname: Liu
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.forename: Maochao
authors.initials: M
authors.lastname: Ding
authors.forename: Maolin
authors.initials: M
authors.lastname: Tang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap
references.citation: Duymaz A, Karabekmez FE, Vrtiska TJ, Mardini S, Moran SL. Free tissue transfer for lower extremity reconstruction: A study of the role of computed angiography in the planning of free tissue transfer in the posttraumatic setting. Plast Reconstr Surg. 2009;124:523–529.
references.citation: Tang M, Mao Y, Almutairi K, Morris SF. Three-dimensional analysis of perforators of the posterior leg. Plast Reconstr Surg. 2009;123:1729–1738.
references.citation: Pontén B. The fasciocutaneous flap: Its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34:215–220.
references.citation: Haertsch PA. The blood supply to the skin of the leg: A post-mortem investigation. Br J Plast Surg. 1981;34:470–477.
references.citation: Recalde Rocha JF, Gilbert A, Masquelet A, Yousif NJ, Sanger JR, Matloub HS. The anterior tibial artery flap: Anatomic study and clinical application. Plast Reconstr Surg. 1987;79:396–406.
references.citation: Kim NG, Lee KS, Choi TH, et al.. Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap. J Plast Reconstr Aesthet Surg. 2008;61:934–938.
references.citation: Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The saphenous neurovascular free flap. Plast Reconstr Surg. 1981;67:763–774.
references.citation: Saitoh S, Hata Y, Murakami N, et al.. The ‘superficial’ peroneal artery: A variation in cutaneous branching from the peroneal artery, nourishing the distal third of the leg. Br J Plast Surg. 2001;54:428–433.
references.citation: Kilinc H, Bilen BT, Arslan A. A novel flap to repair medial and lateral malleolar defects: Anterior tibial artery perforator-based adipofascial flap. Ann Plast Surg. 2006;57:396–401.
references.citation: Kim JS, Son DG, Choi TH, et al.. An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps. Ann Plast Surg. 2008;60:710–716.
references.citation: Panagiotopoulos K, Soucacos PN, Korres DS, et al.. Anatomical study and colour Doppler assessment of the skin perforators of the anterior tibial artery and possible clinical applications. J Plast Reconstr Aesthet Surg. 2009;62:1524–1529.
references.citation: Rad AN, Christy MR, Rodriguez ED, Brazio P, Rosson GD. The anterior tibialis artery perforator (ATAP) flap for traumatic knee and patella defects: Clinical cases and anatomic study. Ann Plast Surg. 2010;64:210–216.
references.citation: Schaverien M, Saint-Cyr M. Perforators of the lower leg: Analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg. 2008;122:161–170.
references.citation: Saint-Cyr M, Schaverien M, Arbique G, Hatef D, Brown SA, Rohrich RJ. Three- and four-dimensional computed tomographic angiography and venography for the investigation of the vascular anatomy and perfusion of perforator flaps. Plast Reconstr Surg. 2008;121:772–780.
references.citation: Rees MJ, Taylor GI. A simplified lead oxide cadaver injection technique. Plast Reconstr Surg. 1986;77:141–145.
references.citation: Bergeron L, Tang M, Morris SF. A review of vascular injection techniques for the study of perforator flaps. Plast Reconstr Surg. 2006;117:2050–2057.
references.citation: Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. Plast Reconstr Surg. 2008;122:429–437.
references.citation: Cormack GC, Lamberty BG. Cadaver studies of correlation between vessel size and anatomical territory of cutaneous supply. Br J Plast Surg. 1986;39:300–306.
references.citation: Wang CY, Chai YM, Wen G, et al.. The free peroneal perforator-based sural neurofasciocutaneous flap: A novel tool for reconstruction of large soft-tissue defects in the upper limb. Plast Reconstr Surg. 2011;127:293–302.
references.citation: Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg. 2011;128:151e–157e.
references.citation: Xu DC, Zhong SZ, Kong JM, et al.. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg. 1988;82:305–310.