title: Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique.
abstract: BACKGROUND
  To delineate the distribution and course layer of the perforator vessels using a modified technique.
  
  
  METHODS
  Twelve perforator flaps were obtained from the crura of six fresh adult cadavers. The flaps were randomized into three groups (n = 4 per group): the full-thickness flap group; the deep fascia-free flap group, and the subcutaneous adipose layer-free group. The flaps were smoothened on a silk screen on a batten frame and the isolated flaps were perfused at a perfusion pressure of 140 mmHg for 10 min via the trunk of the posterior tibial artery. Perforator flaps were photographed using a digital camera and radiographed using a mammography device. The imaging data were processed by digital software system.
  
  
  RESULTS
  The mean number of the posterior tibial artery perforator was 4.17 ± 0.94. The three relatively constant perforators varied in the projection points as well as the diameter and the length. The vascular branches and courses of the perforators were clearly visible on the mammograms. Elimination of all the deep fascia or the subcutaneous adipose tissues in the distal portion had no significant impact on the blood supply of posterior tibial artery perforator flaps while the vascular areas of the artery perforators were significantly reduced after the subcutaneous adipose tissue was eliminated in the proximal portion.
  
  
  CONCLUSIONS
  We developed an effective modified technique for delineating the vascular territory on perforator flaps of different thicknesses. Our results provide significant guidance for clinical surgeons by providing them with more detailed anatomical knowledge of perforator flaps.
authors.affiliation: Department of Hand Surgery, Hospital 401 of the People's Liberation Army (PLA), Qingdao, Shandong, China.|Department of Orthopedic and Traumatic Surgery, General Hospital of Jinan Military Command, Jinan, Shandong, China.|Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Dazhi
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Hou
authors.affiliation: Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Antang
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Hand Surgery, Hospital 401 of the People's Liberation Army (PLA), Qingdao, Shandong, China.
authors.forename: Haiping
authors.initials: H
authors.lastname: Tang
authors.affiliation: Department of Hand Surgery, Hospital 401 of the People's Liberation Army (PLA), Qingdao, Shandong, China.
authors.forename: Guangrong
authors.initials: G
authors.lastname: Fang
authors.affiliation: Department of Hand Surgery, Hospital 401 of the People's Liberation Army (PLA), Qingdao, Shandong, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhai
authors.affiliation: Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China. dosjh@126.com.
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Orthopedic and Traumatic Surgery, General Hospital of Jinan Military Command, Jinan, Shandong, China. drydz@126.com.
authors.forename: Xuecheng
authors.initials: X
authors.lastname: Cao
mesh_terms: D000328:Adult; D006801:Humans; D061525:Perforator Flap; D016909:Tibial Arteries / Q000033:anatomy & histology*
keywords: Anatomy; Human cadaver; Modified technique; Perforator flap; Radiograph