Perforator vessel recipient options in the lower extremity: An anatomically based approach to safer limb salvage

Nicholas Haddock, Evan S. Garfein, Derek Reformat, Elizabeth Hecht, Jamie Levine, Pierre Saadeh

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

When free tissue transfer is employed for defects of the lower third of the leg, recipient anastomoses are typically performed to major vessels. The aim of this study was to assess soleal perforators located in the distal half of the leg as potential vessels for free flap recipient vessels. Six fresh cadavers (12 limbs) were dissected. Perforators of adequate size (1 mm) were documented as was the location and ease of dissection. Lower extremity magnetic resonance angiograms (MRAs) of 18 extremities were retrospectively reviewed. Two free tissue transfers to lower extremity perforators were presented. Soleal perforators most reliably matched our recipient vessel requirements. Perforators were of adequate size to support free tissue transfer, easy to dissect, and were located at mid/distal fibula level. MRA evaluation confirmed these results. One free tissue reconstruction was performed for trauma (posterior tibial perforator) and one was performed for a chronic radiation wound (peroneal perforator). The soleus muscle is easily exposed and is supplied distally by perforators from both the posterior tibial and the peroneal artery systems. These perforating branches are more accessible than the major lower extremity arteries, making the exposure and anastomosis technically easier and sparing potential iatrogenic injury to critical vessels.

Original languageEnglish (US)
Pages (from-to)461-469
Number of pages9
JournalJournal of Reconstructive Microsurgery
Volume26
Issue number7
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Limb Salvage
Lower Extremity
Leg
Angiography
Wounds and Injuries
Magnetic Resonance Spectroscopy
Extremities
Tibial Arteries
Fibula
Free Tissue Flaps
Cadaver
Dissection
Skeletal Muscle
Arteries
Radiation

Keywords

  • lower extremity reconstruction
  • microsurgery
  • Perforator
  • recipient vessel

ASJC Scopus subject areas

  • Surgery

Cite this

Perforator vessel recipient options in the lower extremity : An anatomically based approach to safer limb salvage. / Haddock, Nicholas; Garfein, Evan S.; Reformat, Derek; Hecht, Elizabeth; Levine, Jamie; Saadeh, Pierre.

In: Journal of Reconstructive Microsurgery, Vol. 26, No. 7, 2010, p. 461-469.

Research output: Contribution to journalArticle

Haddock, Nicholas ; Garfein, Evan S. ; Reformat, Derek ; Hecht, Elizabeth ; Levine, Jamie ; Saadeh, Pierre. / Perforator vessel recipient options in the lower extremity : An anatomically based approach to safer limb salvage. In: Journal of Reconstructive Microsurgery. 2010 ; Vol. 26, No. 7. pp. 461-469.
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