Can we consider standard microsurgical anastomosis on the posterior tibial perforator network? An anatomical study.
OBJECTIVE
The main vessels in an injured leg can be spared with perforator-to-perforator anastomosis. However, supermicrosurgery is not a routine procedure for all plastic surgeons. Our objective was to establish if the diameter of the perforators of the leg could allow anastomosis with standard microsurgical procedures.


METHODS
Twenty lower legs harvested from ten fresh cadavers were dissected. Arterial and venous vessels were injected with colored latex. The limbs were then dissected in a suprafascial plane. All the perforating arteries of a diameter >0.8 mm were located and their external diameter, the number and external diameter of the venae comitantes were reported.


RESULTS
We found at least three tibial posterior artery perforators with diameters >0.8 mm per leg with a mean external diameter of 1.1 mm and one vena comitans in almost all cases (96 %). The vena comitans was usually bigger than the perforating artery with a mean diameter of 1.6 mm. After statistical analysis, we were able to locate two main perforator clusters: at the junctions of the upper two-thirds of the leg and of the lower two-thirds of the leg.


CONCLUSIONS
The low-morbidity concept of perforator-to-perforator anastomosis can apply to posterior tibial artery perforators without using supermicrosurgical techniques. This is of high interest for open leg fractures where main vessels could be injured. We hope that the results of our study will incite surgeons to consider sparing of main vessels for coverage of open leg fractures whether surgical teams master supermicrosurgery or not.
Plastic and Reconstructive Surgery Unit, CHU Toulouse Rangueil, 1 avenue Jean Poulhès, 31400, Toulouse, France, harold.eburdery@gmail.com.
Harold
H
Eburdery
Benoît
B
Chaput
Aymeric
A
Andre
Jean-Louis
JL
Grolleau
Jean-Pierre
JP
Chavoin
Frederic
F
Lauwers
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013977:Tibia / Q000098:blood supply* / Q000601:surgery*