Anatomical study of the perforating vessels of the lower leg

Difficulty of soft tissue defects of the lower leg demands the development of new methods to treat such defects. The aim of this study is the examination of perforators and the various ways of blood supply to the skin in the lower leg. Provided with certain regularity, we would be able to cure soft-tissue defects also in the difficult zone of the distal segment and on the dorsum of the foot not harming vessels and not affecting mobility of muscles. Subcutaneous island-flaps supplied by perforating vessels could replace free flaps. By saving the crural fascia of 10 lower legs we flayed layers of skin and fat, marked the perforating vessels with pins, and photographed and documented them. Specimens were divided into a proximal, an intermediate and a distal segment, each of them subdivided into a medial, lateral and dorsal section. The perforators, which can be classified as septocutaneous and musculocutaneous vessels, followed a reproducible pattern all over the lower leg. All vessels were sufficient in number as well as in size. Additionally these perforators can easily be identified by colour-coded sonography. The knowledge that perforators in the lower leg occur regularly enables the development of a new operative approach in therapy of soft-tissue defects in this region with the advantage, that the vessels used can be selected preoperatively.