Vascularized plantaris tendon graft: anatomic study of the donor

In order to determine new vascularized donor tendons for grafting, a detailed anatomic study of the plantaris tendon and vascular connections with the posterior tibial artery or its branches was undertaken in 20 legs of 10 fresh adult cadavers. A histologic evaluation was also undertaken. Findings demonstrated that there is a close vascular connection between the crural fascial-linked section of the plantaris tendon and the posterior tibial artery. Through its rich surrounding paratenon, the blood supply of the tendon is provided by two to four transfascial branches of the posterior artery in the lower-middle portion of the leg. Out of these branches, one or two anastomosing arteries (more than 1.0 mm in diameter), together with accompanying veins, consistently emerge 5 to 8 cm from the insertion of the plantaris tendon. Histologic observations demonstrate the reliable vascularity of the paratenon and crural fascia. The authors consider this vascularized tendon donor a good option for grafting. A composite tendofascial flap with vascularized pedicle from the posterior tibial artery or an isolated vascularized tendon graft from its branches would both be alternative techniques for clinical vascularized tendon grafting.