title: Redefining the Vascular Classifications of the Lateral Supramalleolar Flap.
abstract: BACKGROUND
  The blood supply of the lateral supramalleolar flap (LSMF) generally comes from the perforating branch of the peroneal artery. However, the cutaneous branch may also receive blood from the anterior tibial artery. The main objective of the present study was to clarify the vascular anatomy of the LSMF.
  
  
  METHODS
  Anatomical dissections were performed on 28 perfused fresh cadaver legs. The cutaneous branches of LSMF were identified, and the anatomic relationship between the cutaneous branches and the peroneal and anterior tibial arteries was analyzed.
  
  
  RESULTS
  The vascular supply for LSMF was divided into 2 main types. A collateral inferolateral branch from the anterior tibial artery anastomosed with the perforating branch of the peroneal artery around the inferior tibiofibular angle, and the main cutaneous branch of the flap arose from this arterial anastomosis in 20 of 28 limbs (71.4%). The collateral inferolateral branch was absent or very small in the other 8 of 28 dissections (28.6%), and the cutaneous branches solely arose from the perforating branch of the peroneal artery. The anastomosis of the descending branch of the peroneal artery and anterior lateral malleolar artery was always (100%) found around the tibiotalar joint.
  
  
  CONCLUSIONS
  In addition to the perforating branch of the peroneal artery, the LSMF may also receive blood from the anterior tibial artery through the collateral inferolateral branch. New modified proximally based flaps could be designed, and caution is warranted for these variations when a distally based flap is performed.
authors.affiliation: From the *Department of Orthopaedics, Shanghai Institute of Traumatology and Orthopaedics, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine; and †Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Rong
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.forename: Li-Wen
authors.initials: LW
authors.lastname: Hao
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Xu
authors.forename: Zeng-Tao
authors.initials: ZT
authors.lastname: Wang
mesh_terms: D000368:Aged; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D016909:Tibial Arteries / Q000033:anatomy & histology* / Q000601:surgery