Studio anatomico dei rapporti neurovascolari delle perforanti dell’arteria tibiale posteriore: applicazioni alla chirurgia ricostruttiva dell’arto inferiore

Purpose: the aim of this dissection study is to evaluate the anatomic localization of the most distal perforator of the posterior tibial vessels and to study its relationships with saphenous nerve and saphena magna vein to provide an anatomical rationale for the safe harvesting of distal leg flaps. In order to do so, we have developed a new contrast agent for comparative CT and dissection studies of the vascularisation of cadaveric specimens.Methods: The material was an epoxy resin especially with the addition of barium sulfate. Once our injection protocol was validated, we identified the most distal perforator from posterior tibial perforator artery in 36 lower limbs from 18 cadavers; its relationships with saphenous nerve and saphena magna vein were analysed.Results: There was a perfect correspondence between image studies and dissections. A distal posterior tibial artery perforator was found in all specimens, the distance between the lowest perforator and the medial malleolus ranged from 3.5 to 8.2 cm. Its branches formed a plexus around saphena magna vein before vascularizing the skin. We found also many anastomoses with the perineural plexus of saphenous nerve but not relevant cutaneous branches originating from it.Conclusions: the new contrast agent proposed may help realising detailed vascular studies comparing CT and dissection. Our data suggest some safety parameters to make the rising of a medial leg flap safer in surgical practice.