• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.290-295
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• 2018

저자는 종아리동맥의 천공지를 이용하여 발목을 재건하려는 중 천공지가 절단되어 비복신경과 복재정맥만 보존된 피판의 성공적인 생존을 경험하였다. 24세 아시안 남성에서 전신마취 하에 종아리 동맥 천공지, 복재정맥, 비복신경을 확인하고 보존하고 피판을 회전시키는 과정에서 종아리 동맥 천공지의 절단이 발생하였다. 천공지의 손상에도 불구하고 피판의 경계에서 혈행이 확인되었다. 수술 후 환자는 특이 합병증 없이 회복되었고, 미용적인 결과와 기능적인 결과에서 모두 만족스러웠다. 몇몇 연구에서 비복신경과 동반하는 혈행을 보고하고 있다. 결과적으로, 종아리 동맥의 천공지 없이 비복신경과 동반하는 동맥의 혈류만으로도 충분한 혈액 공급이 가능하였다. 따라서 어느 환경에서나 그리고 어느 부위에서나 피판의 천공지뿐만 아니라 신경-혈관을 보존하는 것이 중요하다.

• Tuberculosis and Respiratory Diseases
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• 제43권5호
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• pp.779-785
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• 1996

저자 등은 두통과 비루를 주소로 내원한 46세 남자에서 비강, 폐, 신장을 침범하고, 양측 전경골 동맥과 비골 동맥 폐쇄를 동반한 베게너 육아종증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.695-699
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• 2006

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.

• Annals of Clinical Neurophysiology
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• 제14권2호
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• pp.72-75
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• 2012

Ischemic monomelic neuropathy and myopathy are rare complications of peripheral arterial occlusive disease. We report a case of ischemic monomelic neuropathy of the right sural, common peroneal and posterior tibial nerves and ischemic myopathy of the right tibialis anterior resulting from the occlusion of the right common femoral arteries despite successful revascularization. Ischemic monomelic neuropathy and myopathy can occur as a result of occlusion of the specific peripheral artery.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.253-257
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• 2022

The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.

• 대한정형외과학회지
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• 제55권5호
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• pp.431-435
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• 2020

주로 고에너지 손상이나 관통상에 의해서 발생하는 가성동맥류는 진단이 지연되면 심각한 결과를 초래할 수 있다. 저자들은 계단에서 넘어져 다친 후 처음에는 단순 타박 및 피부 열상으로 진단되었다가 증상이 악화되어 수상 2주일 후 시행한 자기공명영상 검사와 컴퓨터 단층촬영 혈관 조영술에서 경골 동맥의 경골비골동체의 가성동맥류로 뒤늦게 진단된 63세 남자를 치험하였다. 경한 둔상에 의하여 경골비골동체에 가성동맥류가 발생한 예는 아직까지 국내에 보고된 바 없어 이에 저자들은 문헌고찰과 함께 보고하고자 한다.