The suprafascial course of lower leg perforators: An anatomical study

• Published in: Archives of plastic surgery Vol. 47; no. 2; pp. 165 - 170
• Main Authors: Vaienti, Luca, Cottone, Giuseppe, De Francesco, Francesco, Borelli, Francesco, Zaccaria, Giovanna, Amendola, Francesco
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Thieme Medical Publishers, Inc 01.03.2020; Korean Society of Plastic and Reconstructive Surgeons; 대한성형외과학회
• Subjects: arteries; lower extremity; Original; Original Article; perforator flaps; 성형외과학; Perforator flaps; Lower extremity; Arteries
• ISSN: 2234-6163; 2234-6171
• DOI: 10.5999/aps.2019.00962

Background Perforator mapping has been well described in the literature. Once the suprafascial plane is reached, the course of perforators is considered constant. However, the surgeon must be aware of whether an anastomosis exists between perforators superficially to the fascia, in order to choose the best vessel upon which to base the reconstruction. Our retrospective in vivo anatomical study of lower leg perforator flaps presents the first description of variations in the suprafascial path of perforators, which may influence preoperative flap design. Methods An anatomical study of lower limb perforators was performed on 46 nonconsecutive patients who were referred to our department from June 2012 to October 2018. Reconstruction with perforator-based propeller flaps was planned for each of the patients. In total, 72 perforators were preoperatively identified and surgically isolated. The suprafascial course of each perforator was reported. Results During suprafascial surgical exploration, branching patterns were observed in four perforators. These perforators had been classified as single vessels in the preoperative ultrasonographic analysis. However, after surgical dissection, distal converging branches were noted in two of them. Conclusions Our study is the first description in the literature of suprafascial converging perforators, which might constitute an obstacle to planned reconstruction procedures. Despite the accuracy of preoperative evaluations, anatomical variations were present. Knowledge of suprafascial perforator variations may help surgeons to choose the correct perforator upon which to base a planned flap.