Versatility of the Osteocutaneous Anterior Tibial Flap System for Lower-Limb Reconstruction

• Published in: Journal of Reconstructive Microsurgery
• Main Authors: Peng, Y.P., Heng Pho, Robert Wan
• Format: Conference Proceeding
• Language: English
• Published: 26.07.2006
• ISSN: 0743-684X; 1098-8947
• DOI: 10.1055/s-2006-949006

The authors described the use of the anterior tibial artery system for pedicled composite tissue transfer for ipsilateral lower-limb reconstruction. The long vascular pedicle of the anterior tibial vessel system allowed the performance of fusion of the knee and ankle joints, and resurfacing of the foot and toes, based on antegrade or retrograde flow from anastomosis around the ankle joint. Five to seven periosteal perforators originate evenly along the length of the anterior tibial artery, lying on the lateral surface of the tibia to reach the anterolateral skin of the leg. Cutaneous, bone, or composite osteocutaneous flaps can be harvested based on these perforators. The anterior and posterior tibial artery systems communicate at the ankle anastomosis formed by the malleolar and tarsal arteries, and further distally at the deep plantar artery. Versatility is possible because the pivot point of the pedicled transfer can be designed along the length of the anterior tibial artery. A long straight corticocanellous graft can be raised from the anterolateral tibia for antegrade transfer for knee joint fusion or transferred distally for ankle fusion. A reversed pedicled skin flap can also be raised to resurface the dorsum of the foot or toes. This technique limits surgery to the same limb, thus reducing the donor-site morbidity and surgical logistics required. Mobilizing the distal two-thirds of the anterior tibial system and the deep peroneal nerve does not result in muscle ischemia or denervation of the anterior compartment muscles of the leg, as the major muscle branches are given off in the proximal third of the leg. The authors have performed 9 cases with various reconstructions. Vascularized tibial grafts of up to 25 cm were used to augment knee fusion after resection of osteosarcoma of the distal femur in 2 cases, and for ankle fusion in 1 case. Joint fusion was achieved in these cases. The reversed pedicled anterior tibial skin flap was used to resurface the dorsum of the foot after trauma in 2 cases, and to resurface the big toe donor site in 4 cases. There were no failures for the skin flaps, giving a resurfacing outcome that is thin, supple, yet more durable than skin grafting. There were no complications at the donor site, and no patients reported problems with foot or toe extension weakness. The anterior tibial artery system can be reliably utilized to reconstruct a variety of defects in the ipsilateral lower limb with little morbidity.