The small saphenous vein (SSV) is an important graft in limb salvage surgery. It is frequently translocated for bypass surgery. Sometimes, the use of the SSV as an in-situ graft for posterior tibial artery or peroneal artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Recently, saphenous vein mapping through computed tomography (CT) volume rendering technique offers a great quality view to the surgeon. We experienced a patient in whom a CT image with volume rendering technique revealed an aberrant SSV connected with the great saphenous vein at the medial malleolus level. This case indicates that an aberrant SSV may be successfully used as an in-situ conduit for bypass to the dorsalis pedis artery. Here, we present the case of a popliteal-to-dorsalis pedis in-situ vein bypass using a LeMaitre valvulotome (LeMaitre Vascular Inc., USA) under mapping of the aberrant SSV by CT volume rendering technique.
Arteries ; Humans ; Limb Salvage ; Saphenous Vein* ; Tibial Arteries ; Transplants ; Veins

Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain.
Ankle ; Ankle Joint* ; Arteries ; Cadaver ; Classification ; Diagnosis ; Foot ; Humans ; Tibial Arteries* ; Tibial Nerve*

In the distal third of the tibia, the anterior tibial artery runs close to the anterolateral surface of the tibial cortex. In a clinical situation, without vascular evaluation, injury or entrapment of the anterior tibial artery is difficult to detect. Because, an intact dorsalis pedis pulse is supplied with the collateral vessels of the posterior tibial artery. An entrapped anterior tibial artery can be injured during closed reduction in an emergency room or open reduction and internal fixation in the operating room. Care must be taken to prevent iatrogenic anterior tibial artery. In this case, an entrapped anterior tibial artery was observed in a simple radiograph and computed tomograph without contrast media for the vessel. We report on a rare case of calcified anterior tibial artery entrapment in a distal tibial fracture.
Contrast Media ; Emergency Service, Hospital ; Operating Rooms ; Tibia ; Tibial Arteries* ; Tibial Fractures*

PURPOSE: We tried to reveal radiographic clues for the possibility of damages to the important structures, including the peroneal nerve and the anterior tibial artery, caused by a proximal interlocking screw with a medial to lateral oblique direction (ObML-PIS). MATERIALS AND METHODS: The length of the proximal tibiofiular joint (PTFJ) was measured from the tip of the fibular head to the end of PTFJ on the simple oblique radiographs of 22 cases of tibial intramedullary (IM) nailing. The center (O) of the IM nailing, from the tibial anterior cortex at the level of insertion of an ObML-PIS, was measured on the simple lateral radiographs. The angle POA (P: a point 10 mm anterior from the anterior fibular border, A: a point on the tangent line from the O point to the posteromedial cortex of the fibula) was measured on the MR axial view of 60 cases, and within this angle an ObML-PIS could injure the important anatomical structures. Transverse and 45-degree oblique diameters of the proximal tibia on the MR axial view were also measured. RESULTS: The PTFJ length was 18.5+/-3.3 mm and the O point was located at 15.3+/-3.4 mm posterior from the tibial anterior cortex. The angle POA was 21.4+/-6.2-67.8+/-6.7 degrees with medial to lateral oblique directions. The transverse diameter of the proximal tibia was 58.0+/-5.8 mm and the 45-degree oblique diameter was 50.7+/-6.2 mm. CONCLUSION: Special caution may be needed when we use an ObML-PIS because it is located at the level distal from the end of the PTFJ and within the POA angle, and the peroneal nerve and anterior tibial artery can possibly be severed.
Fracture Fixation, Intramedullary ; Head ; Joints ; Nails ; Peroneal Nerve ; Poa ; Tibia ; Tibial Arteries ; Tibial Fractures

Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.
Aneurysm, False ; Embolization, Therapeutic ; Fracture Fixation, Intramedullary ; Nails ; Thrombin ; Tibial Arteries ; Tibial Fractures

Pseudoaneurysm is one of the complications of arterial injuries by trauma. The case report in children is rare, although not in adult. A 7-year and 10-month girl was visited with the complaints of pain and a mass in her right leg. At first, the radiograph of right tibia showed a remarkable cortical erosion from without, suggesting mass effect by a soft tissue tumor. She had a history of fracture of right tibia, and then manipulative reduction and K-wire fixation at 11 months ago. Arteriography showed a formation of the pseudoaneurysm originated from the posterior tibial artery. The operation was done through the ligation of artery at proximal and distal to pseudoaneurysm, and then excision of mass. At 5 year follow-up, the configuration and function of right foot was normal. Eventually, the cause of the mass formation is thought by the trauma of fracture fragment at the time of accidents, but the possibility of penetrated injuries by K-wire should be ruled out, which is used frequently in children's fracture. We experienced a case of traumatic pseudoaneurysm of posterior tibal artery with tibial fracture, especially occurred in pediatric patient, and presented the result of long-term follow-up.
Adult ; Aneurysm, False* ; Angiography ; Arteries ; Child* ; Female ; Follow-Up Studies ; Foot ; Humans ; Leg ; Ligation ; Tibia ; Tibial Arteries* ; Tibial Fractures

Most studies of limb lengthening have concentrated on the osteotomy. In the present study, the response of soft tissue (muscle, artery, nerve) to different length, rates or rhythms of distraction have been investigated to define the nature of any damage and to see whether new muscle is created. The purposes of the this study are to evaluate the optimum condition for soft tissue during limb lengthening and to study the effect of different rates & rhythms of tibial lengthening on the soft tissue in rabbits hy observing the changes of muscle, artery and nerve. We lengthened the right tihiae of fifty-four growing New Zealand white rabbits by callotasis. The left tibiae were used as control. The rabbits were divided into three different rates & rhythms groups: Group 1 (increments of 0.5mm /day, divided 2 times/day), Group II (increments of 0.5mm/day, divided 3 times/day), Group III (increments of 10mm/day, divided 2 times/day). Each Group was subdivided into three lengthening groups: 1 ( 10% lengthening), 2 (20% lengthening), 3 (30% lengthening). At the end of lengthening, histopathologic & histomorphometric studies were done on the medial heads of gastrocnemius muscles, the posterior tibial artery and the posterior tibial nerve. In the histopathological study, these were stained by hematoxylin eosin, PAS and observed by light microscopy. Electron microscopic examination was done in all samples. In light microscopic findings, the sum of scores of the following five suhjects, each counted from 0 to 3, were analysed for individual groups between the experimental side and the control by the Mann-Whitney test and the kruskal-Wallis test. The following conclusions were made hased on the above observations; 1. There was no significant difference between groups I, II and III, but there was a significant dif-ference between the 10%, 20% and 30% lengthening groups by histopathologic study. And the predominant responses of muscle to the lengthening were atrophy and endomysial fibrosis. 2. There was no change in the proportion of the muscle fiber types by histomophomeric study. 3.ln the initial phase, the muscle adaptation to the gradual lengthening was attained by sliding in Jess than 20% distraction but finally the muscle was regenerated by new muscle formation. 4. Major soft tissue complication to the gradual lengthening was induced by muscle. But arteries & nerves were well adapted to the gradual lengthening up to 30% Iengthening.
Arteries ; Atrophy ; Eosine Yellowish-(YS) ; Extremities ; Fibrosis ; Head ; Hematoxylin ; Microscopy ; Muscles ; Osteogenesis, Distraction ; Osteotomy ; Rabbits* ; Tibia ; Tibial Arteries ; Tibial Nerve

Refinements in surgical technique have resulted in significant improvement in the patency rates of infrapopliteal artery revascularizations, but the cumulative patency rate were still low. Possibly the principle cause for the late graft failure was the constricting scar formation around the distal anastomosis following surgical injury. Thus we adopted a nondissection method, using pneumatic tourniquet occlusion technique, to simplify the procedure of distal anastomosis and to lessen the surgical injury. Six patients underwent infrapopliteal artery revascularizations with this method. Three of them were diagnosed with arteriosclerosis obliterans and the others with thromboangiitis obliterans. Tourniquet pressures of 350 mmHg were applied from 32 to 60 minutes. All patients were given systemic anticoagulants. The distal anastomoses were performed to peroneal artery in three cases, posterior tibial artery in two, and anterior tibial artery in one. Hemostasis was adequate in all cases and no alternative occlusive devices were required. There were no complications attributable to the use of the pneumatic tourniquet. Therefore we suggest that tourniquet occlusion technique may simplify the infrapopliteal artery revascularization and minimize surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.
Anticoagulants ; Arteries* ; Arteriosclerosis Obliterans ; Cicatrix ; Hemostasis ; Humans ; Intraoperative Complications ; Thromboangiitis Obliterans ; Tibial Arteries ; Tourniquets* ; Transplants

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.
Arteries* ; Axis, Cervical Vertebra ; Cadaver* ; Fibula ; Head ; Leg* ; Peroneal Nerve* ; Skin ; Sural Nerve ; Tibial Arteries

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.
Arteries* ; Axis, Cervical Vertebra ; Cadaver* ; Fibula ; Head ; Leg* ; Peroneal Nerve* ; Skin ; Sural Nerve ; Tibial Arteries