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True and Choke Anastomoses between Perforator Angiosomes: Part I. Anatomical Location

Taylor, G. Ian A.O., M.D.; Chubb, Daniel P. M.B.B.S., B.Med.Sci.; Ashton, Mark W. M.B.B.S., M.D.

doi: 10.1097/PRS.0b013e3182a80638
Experimental: Original Articles
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Background: Reports of more than two cutaneous perforator angiosome territories being raised successfully in distally based sural flaps are appearing in the literature. Previous anatomical studies have noted that cutaneous arteries, connected by true anastomosis without change in caliber, frequently parallel cutaneous nerves.

Methods: Twenty-four (48 sides) total body lead oxide cadaver injection studies, including seven arterial and two venous neurovascular, were examined, and the results were compared with clinical thermography in Part II.

Results: Long branches of cutaneous perforators, connected in a series by true anastomoses, paralleled at variable distances the main trunks of cutaneous nerves in the head, neck, torso, and upper and lower extremities. Specifically, in the leg, an average of 3.2 true anastomoses (range, 1 to 5) connected perforators that paralleled the sural nerve on the back of the calf; and 2.5 (range, 1 to 4) connected perforators on the medial side of the leg. These vascular freeways were paralleled by the short and long saphenous veins, respectively.

Conclusions: True anastomoses frequently connect skin perforators that course in parallel with cutaneous nerves and veins. They provide an explanation for the long viable flaps noted in the leg, and it will be shown in Part II that they can be detected preoperatively with thermography.

Parkville, Victoria, Australia

From the Department of Anatomy and Neuroscience, University of Melbourne.

Received for publication February 6, 2013; accepted June 26, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Daniel P. Chubb, M.B.B.S., B.Med.Sci., Taylor Laboratory, Room E533, Department of Anatomy, University of Melbourne, Grattan Street, Parkville 3050, Victoria, Australia, dantendo@gmail.com

©2013American Society of Plastic Surgeons