Three-Dimensional Analysis of Perforators of the Posterior Leg

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Three-dimensional evaluations of cutaneous perforator vessels provide useful clinical information to aid in the design of perforator flaps. By combining three-dimensional digital imaging and angiography, the authors developed a new three-dimensional visualization technique for vascular perforators. Their purpose was to produce a digitized model of the posterior leg to determine the anatomical relationships of perforators in each zone of the posterior leg.


Eight cadavers were injected with a modified lead oxide–gelatin mixture. Two cadavers were selected for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software. Dissection, angiography, and photography of each layer were performed to outline the course of every perforator in the posterior leg. The area of the vascular territory supplied by each source vessel was calculated. Surface areas were measured using Scion Image software.


The arterial supply to the integument of the posterior leg was divided into proximal, middle, and distal zones. There were 13 ± 2.3 perforators with diameters of greater than or equal to 0.5 mm; the average external diameter was 0.8 ± 0.2 mm. Each perforator supplied an average area of 38 ± 9.0 cm2. Perforators from the popliteal artery were large and consistent and supplied an average area of 55 ± 20 cm2; there were multiple anastomoses between perforators from the popliteal, posterior tibial, and peroneal arteries. The distal zone received its arterial supply from two to three smaller septocutaneous perforators, which are arranged longitudinally in one to two parallel chains.


The posterior leg is an excellent donor site for local and distant flaps. Perforator flaps could be based in a variety of ways from each zone.

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