Leg perforators and leg length: an anatomic study focusing on topography and angiogenesis

The highly variable anatomic distribution of lower leg perforators is explored, with a standardization based on leg length. The possibility of a correlation between leg length and number of perforators is investigated. Twenty-two lower limbs of cadavers were utilized for an anatomic study on the leg perforators branching from the three major vascular axes, anterior tibial, posterior tibial, and fibular. The parameters considered were the number of vascular pedicles per each major axis, the caliber, the distance of the fascial hole from the bony landmark (knee joint line), and the route of the vessels (muscular, septal). Arteries taken into account had a caliber of 0.5 mm or greater, with a maximum of 1.7 and a mean of 0.78. The perforators of the anterior tibial artery distribute along the entire length of the leg, but the peak of concentration is between second and third tenth and around the middle tenth. The fibular system provides perforators between the fourth and seventh tenth. The posterior tibial perforators concentrate to the middle third and to the supramalleolar region. A correlation exists between leg length and number of perforating vessels for the tibial vascular systems, possibly due to neoangiogenesis during growth, at the level of the metaphyseal plates. On the contrary no relationship was noticed for the fibular artery, whose perforators concentrate far from the growth cartilages. Some tenths where perforators concentrate are identifiable. Tibial systems have a perforator incidence depending on leg length, which, on the contrary, does not influence the number of fibular perforators.