AN ANATOMIC STUDY OF ADIPOFASCIAL FLAP OF THE LEG

Objective: To investigate the vascular anatomy of the subcutaneous tissues and fascias of the leg. Methods Four fresh cadaver legs which had been injected with colored latex were dissected under magnification to identify the origin, course an distribution of vessels from the subfascial level to the skin. The adipofascial flap was harvested from the whole medial side of the leg and fascial flap from other leg of the same cadaver. The posterior tibial artery and its first and second supra-malleolus septal arteries were retained in these flaps. Selective injection of China ink through posterior tibial artery was carried out, and dimension of inkstained areas was recorded. Results Three main trunk vessels of the leg gave off branches to deep fascia and subcutaneous tissues, forming a large vascular plexus in the subcutaneous tissues on the deep fascia and a delicate, but dense and well anastomosed vascular plexus beneath the deep fascia. The vascular plexus in the subcutaneous tissues ran deeper than the superficial venous system. The areas stained by selective injection in adipo fascial flaps were larger than those in the fascial flaps. Conclusion Subcutaneous tissues and deep fascia can he considered as an anatomic entity nourished by two very well developed vascular networks which lie on both sides of deep fascia. Incorporation of the deep fascia can not only protect the subcutaneous tissue from being lacerated during raising of the flap, but also enhance vascularity of the adipofascial flap. leaving superficial veins intact while raising the skin flap does not jeopardize the vascular plexus in the subcutaneous tissues and can preserve the superficial lymphatic vessels, so that postoperative edema of the flap or the leg could be avoided.