title: Anatomical study of anterior supramalleolar artery and its potential application to design a bi-foliate fasciocutaneous flap.
abstract: OBJECTIVE
  A further understanding of the anterior supramalleolar artery (ASMA) and its potential applications in reconstructive surgery.
  
  
  METHODS
  A total of 24 fresh lower limbs from fresh cadavers were injected with red latex for dissection. The type of origin, course, diameter of the pedicle, and the distance between the origin of the ASMA from the anterior tibial artery to the extensor retinaculum (O-R) were recorded. Bi-foliate fasciocutaneous flaps were harvested using the branches of the ASMA.
  
  
  RESULTS
  We found four types of origin of the ASMA, and we have accordingly classified them into four types. 10 of them were type A, 7 were type B, 6 were type C and 1 was type D. The mean O-R (origin of ASMA to retinaculum) distance was 2.0 ± 0.8 cm. The diameter of the medial branch (D1), the diameter of the lateral branch (D2), and the diameter of artery stem (D3) (only in type A) were 1.0 ± 0.2 mm, 0.8 ± 0.3 mm, 1.1 ± 0.2 mm, respectively. The mean pedicle length of the lateral flap (L1) and medial flap (L2) were 5.1 ± 1.0 cm and 3.7 ± 0.6 cm, respectively.
  
  
  CONCLUSIONS
  The ASMA exists constantly with four different types of origin. Its sizable diameter and lengthy pedicle make it suitable for bi-foliate fasciocutaneous flap transfer.
authors.affiliation: Department of Plastic Surgery, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Ji-Yin
authors.initials: JY
authors.lastname: He
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shih-Heng
authors.initials: SH
authors.lastname: Chen
authors.affiliation: Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA.
authors.forename: Kannan Karuppiah
authors.initials: KK
authors.lastname: Kumar
authors.affiliation: Department of Plastic Surgery, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Fan
authors.affiliation: Department of Hand Surgery, Huashan Hospital Affiliated Fudan University, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Lao
authors.affiliation: Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA.
authors.forename: Huey
authors.initials: H
authors.lastname: Tien
keywords: Anterior supramalleolar artery; bipaddle flaps; fasciocutaneous flaps; multiple defects