Available online 4 April 2024, 152262

Author links open overlay panel, , , , , , , , , ABSTRACTBackground

The perforator flap has garnered significant interest since its inception due to its advantage of not needing a vascular network at the deep fascial level. Perforator flaps are commonly utilized in different flap transplant surgeries, and the thigh flap is presently the most widely used perforator flap. Is it possible for the calf to replace the thigh as a more suitable site for harvesting materials? Currently, there is a lack of relevant anatomical research. This study aims to address this question from an anatomical and imaging perspective.

Methods

This study used cadavers to observe the branches and courses of perforators on the calf and the distribution of skin branches using microdissection techniques, digital X-ray photography, and micro-computed tomography techniques.

Results

The perforators had three main branches: the vertical cutaneous branch, the oblique cutaneous branch, and the superficial fascial branch. The superficial fascial branch traveled in the superficial fascia and connected with the nearby perforators. The vertical and oblique cutaneous branches entered the subdermal layer and connected with each other to create the subdermal vascular network.

Conclusions

We observed an intact calf cutaneous branch chain between the cutaneous nerve and the perforator of the infrapopliteal main artery at the superficial vein site. Utilizing this anatomical structure, the calfskin branch has the potential to serve as a substitute for thigh skin flap transplantation and may be applied to perforator flap transplantation in more locations.

Section snippetsINTRODUCTION

The advancement of microsurgical technology has resulted in the utilization of autologous flaps for repair and reconstruction (Chauhan et al., 2017, Blum et al., 2018). Understanding the survival and vascular architecture of the flap is essential, from basic functional repair to the restoration of cosmetic appearance (Gstoettner et al., 2019, Gómez Díaz and Cruz Sánchez, 2016, Taylor et al., 2011, Taylor et al., 1994). Various types of flaps, including random flaps, axial flaps, and perforator

MATERIALS AND METHODS

Fourteen fresh adult lower limb specimens obtained from the Morphological Experimental Center of the University were used in the study. The specimens were from 12 men and two women with an average age of 70 years at the time of death. All specimens were severed at the midshaft of the femur and showed no evidence of trauma or surgical scars on the surface. The study was approved by the Medical College of University ethics committee.

All specimens were intubated via the femoral artery using a

Branches and distribution of perforators in SF

Reconstructed micro-CT scanning data and observation of the microscopic anatomy revealed three main types of perforator branches: the vertical cutaneous branch (VCB), oblique cutaneous branch (OCB), and the superficial fascial branch (SFB).

VCB traveled from its takeoff point downwards to the subcorium. OCB followed two courses, one of which traveled mainly through SF and finally entered the subcorium and another that traveled gradually towards the subcorium and formed subdermal anastomotic

Vascular architecture of a CBC flap from the lower leg

The concept of a skin branch chain flap may not be completely accurate but is based on the theory of the blood supply of the perforator and axial flaps. The blood supply of the skin branch chain flap depends on the vascular chain formed by the branches of the perforators and adjacent perforators. The main advantage is that there is no need to cut the deep fascia or to over-excavate the blood vessels in the muscle tissue and muscle space. Instead, it is possible to use the vascular chain

Conclusion

Through the study of the connection between the perforate in the skin and the superficial fascia and the distribution of the cutaneous branch chain. This study believes that the calfskin branched skin flap can be used in a wider range of clinical applications and provides an anatomical theoretical basis for this.

Ethical approval

All experiments were performed in accordance with the ethical standards of the Declaration of Helsinki and its later amend-ments. On 1 January 2022, the local Institutional Review Board (Ethics Committee of Yanbian University School of Medicine) reviewed and approved this study (approval numbers: 2310107. Written informed consent was obtained from the patients for publication and any accompanying images.

Author contribution

Xin Wang, Zao-Peng He, Xiang-Zheng Qin: conceptualized the study; Zao-Peng He, Ye Sun, Yi-Ran Yang, Ling-Na Qi, Jing-Han Yang and Yu-Tong Shi carried out the work of formulating or designing methods, creating models and conducting experiments. Xin Wang, Liang-Chang Li, Yan-Qun Liu played the role of Writing – original draft. Ye Sun, Yi-Ran Yang and Xiang-Zheng Qin played the role of Writing – review & editing. All authors reviewed, edited, and approved the final manuscript.

Presentation (for original articles only)

None

Funding

This study was supported by the Natural Science Foundation of China (31860294) and the Jilin Provincial Subject Fund (No. YDZJ202201ZYTS208).

Ethical statement

All experiments were performed in accordance with the ethical standards of the Declaration of Helsinki and its later amend-ments. On 1 January 2022, the local Institutional Review Board (Ethics Committee of Yanbian University School of Medicine) reviewed and approved this study (approval numbers: 2310107. Written informed consent was obtained from the patients for publication and any accompanying images. To the best of our knowledge, the authors have no conflict of interest, financial or

CRediT authorship contribution statement

Ye Sun: Writing – review & editing, Writing – original draft, Conceptualization. LingNa qi: Writing – original draft, Data curation, Conceptualization. Yi Ran yang: Writing – original draft, Data curation, Conceptualization. YanQun liu: Writing – original draft, Conceptualization. LiangChang LI: Writing – original draft, Data curation, Conceptualization. qin xiangzheng: Writing – review & editing, Writing – original draft, Funding acquisition, Data curation, Conceptualization. Yu Tong shi:

Conflict of Interest

The authors declare no competing interests.

Acknowledgements

The authors wish to sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research will potentially improve patient care and increase man kind’s overall knowledge. Therefore, these donors and their families deserve our highest gratitude.

Consent for publication

None

Data Statement

None

References (22)C. Sun et al.An anatomical study on the characteristics of cutaneous branches-chain perforator flap with ulnar artery pedicle

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(2013)

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