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 examinat ion 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 muscle s. 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 f at, marked the perforating vessels with pins, and photographed and document ed them. Specimens were divided into a proximal, an intermediate and a dist al segment, each of them subdivided into a medial, lateral and dorsal secti on. The perforators, which can be classified as septocutaneous and musculocutan eous vessels, followed a reproducible pattern all over the lower leg. All v essels were sufficient in number as well as in size. Additionally these per forators 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 pr eoperatively. (C) 1999 Wiley-Liss, Inc.