The medial malleolar network: a constant vascular base of the distally based saphenous neurocutaneous island flap

Based on 30 fresh cadaver dissections a detailed anatomic study of the medi al malleolar network is presented with particular attention to the anastomo ses between the latter and the vascular axis that follows the saphenous ner ve. The medial malleolar network is formed by the anterior medial malleolar artery, branches from the medial tarsal arteries, the posterior medial mal leolar artery and branches from the medial plantar artery. A distinct anter ior medial malleolar artery and posterior medial malleolar artery could be identified in 80 and 20%, respectively, as well as constant additional smal l branches arising from the anterior tibial or posterior tibial artery. A c onstant anastomosis was found between the arcade formed by the medial tarsa l arteries and the medial plantar a. in 60%, and the medial branch of the m edial plantar artery in 40%, respectively. This anastomosis always gave ris e to branches to the medial malleolar network. In the perimalleolar area an d with regard to the great saphenous v. a larger anterior and a smaller pos terior branch of the saphenous nerve was found in 100 and 90%, respectively . In all dissections, for both branches of the saphenous nerve two to four small, but distinct anastomoses between the medial malleolar network and th e perineural vascular axis were identified. These constant anastomoses repr esent a new and reliable vascular base for the distally-based saphenous neu rocutaneous island flap. Thus, the pivotal point of the flap can be chosen in the area of the medial malleolus without respecting the most distal sept ocutaneous anastomosis between the perineural vascular axis and the posteri or tibial artery. Additionally, an illustrative clinical case is presented.