Angiosomes of the leg: anatomic study and clinical implications

Area of Science:

• Anatomy
• Vascular Surgery
• Radiology

Background:

• The angiosome concept, defining vascular territories, was introduced in 1987.
• Previous studies detailed forearm angiosomes, noting anastomoses within tissues.
• Detailed angiosome mapping of the leg was lacking.

Purpose of the Study:

• To meticulously map the angiosomes of the lower limb (leg).
• To compare leg angiosomes with previously studied forearm angiosomes.
• To provide anatomical data for reconstructive surgery and understanding circulatory compromise.

Main Methods:

• Investigation of 12 lower limbs from fresh cadavers over 2 years.
• Vessel perfusion with radio-opaque lead oxide mixture.
• Dissection, metal clip tagging, radiography, and colored pin mapping of arterial supply to skin, muscles, and periosteum.
• Subtraction radiography to visualize muscle vasculature.
• Cross-section studies for 3D vascular mapping.

Main Results:

• Anastomoses between adjacent angiosomes in the leg primarily occurred within tissues, similar to the forearm.
• Skin, bones, and most muscles received blood supply from multiple angiosomes.
• Muscles in the anterior compartment of the leg were supplied by a single angiosome.
• Identified key anastomotic pathways crucial for circulation reconstitution after arterial interruption.

Conclusions:

• The angiosome map of the leg provides critical anatomical data for vascular surgery.
• The single angiosome supply to anterior leg muscles helps explain clinical syndromes of circulatory compromise.
• Findings aid in designing local or free flaps for tissue transfer and understanding flap viability.