시체 해부를 통한 다리의 얕은종아리신경 동반동맥과 앞근육사이막에 존재하는 관통가지에 관한 해부학적 연구

Anatomical Study of Superficial Peroneal Nerve Accessory Artery and Perforators in the Anterior Intermuscular Septum of Lower Leg Using Cadaveric Dissection

  • 김준식 (경상대학교 의과대학 건강과학연구원, 성형외과학교실) ;
  • 신상호 (경상대학교 의과대학 건강과학연구원, 성형외과학교실) ;
  • 최태현 (경상대학교 의과대학 건강과학연구원, 성형외과학교실) ;
  • 이경석 (경상대학교 의과대학 건강과학연구원, 성형외과학교실) ;
  • 김남균 (경상대학교 의과대학 건강과학연구원, 성형외과학교실)
  • Kim, Jun Sik (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University) ;
  • Shin, Sang Ho (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University) ;
  • Choi, Tae Hyun (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University) ;
  • Lee, Kyung Suk (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University) ;
  • Kim, Nam Gyun (Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University)
  • 투고 : 2006.06.09
  • 발행 : 2006.11.10

초록

Purpose: In the 1990s, skin island flap supplied by the vascular axis of the sensitive superficial nerves had been introduced. For example, neurocutaneous flaps supplied by the vascular axis of the sural nerve and saphenous nerve have been used. But the flap supplied by the vascular axis of superficial peroneal nerve has not been used commonly. Because there have been few anatomical reports about the superficial peroneal nerve accessory artery(SPNAA), we could not apply the neurocutaneous flap supplied by SPNAA. The aim of this study is to investigate the anatomy of SPNAA, number and location of its perforators, and septocutaneous perforators from the anterior tibial artery in anterior intermuscular septum. Methods: So, we dissected a total of eight cadavers. Measurements were made of the positions of the dissected arteries and perforators from the head of the fibula. Results: In all cadavers the superior lateral peroneal artery was originated from the anterior tibial artery and contributed SPNAA. Arising from the anterior tibial artery an average of 5.63 cm inferior to the fibular head, it varied from 10 cm to 16 cm in length. SPNAA gave off an average of 4.38 perforators to supply lateral aspect. In one case the inferior lateral peroneal artery was present and arose from the anterior tibial artery 18 cm inferior to the fibular head. There were an average of 3.38 direct septocutaneous perforators from the anterior tibial artery. Conclusion: Septocutaneous perforators from SPNAA mainly exist from proximal 1/6 to 3/5 of lower leg. In the distal 1/3 of lower leg where the accessory artery was disappeared, exist mainly direct septocutaneous perforators from the anterior tibial artery. Our results can be helpful to applications of the neurocutaneous flap using SPNAA or fasciocutaneous flap based on direct septocutaneous perforators.

키워드

참고문헌

  1. Recalde Rocha JF, Gilbert A, Masquelet A, Yousif NJ, Sanger JR, Matloub HS: The anterior tibial artery flap: anatomic study and clinical application. Plast Reconstr Surg 79: 396, 1987 https://doi.org/10.1097/00006534-198703000-00014
  2. Ponten B: The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34: 215, 1981 https://doi.org/10.1016/S0007-1226(81)80097-5
  3. Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Fukui Y, Miyasaka T, Kodama T, Aiso S, Fujino T: Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 103: 104, 1999 https://doi.org/10.1097/00006534-199901000-00018
  4. Masquelet AC, Romana MC, Wolf G: Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 89: 1115, 1992 https://doi.org/10.1097/00006534-199206000-00018
  5. Hasegawa M, Torii S, Katoh H, Esaki S: The distally based superficial sural artery flap. Plast Reconstr Surg 93: 1012, 1994 https://doi.org/10.1097/00006534-199404001-00016
  6. Masquelet AC, Gilbert A: An Atlas of Flaps in Limb Reconstruction. 1st ed, London, Martin Dunitz, 1995, p 158
  7. Coskunfirat OK, Ozgentas HE: Reversed neurofasciocutaneous island flap based on the vascular supply accompanying the superficial peroneal nerve. Plast Reconstr Surg 108: 1305, 2001
  8. Carriquiry C, Aparecida Costa M, Vasconez LO: An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 76: 354, 1985 https://doi.org/10.1097/00006534-198509000-00003
  9. Cormack GC, Lamberty BGH: The arterial anatomy of skin flaps. 2nd ed, New York, Churchill Livingstone, 1994, p 252
  10. Yousif NJ: The anterior tibial artery flap. In Serafin D (ed): Atlas of microsurgical composite tissue transplantation. 1st ed, Philadelphia, WB Saunders, 1996, p 459