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Peripheral Vessel Doppler
Published in Swati Goyal, Essentials of Abdomino-Pelvic Sonography, 2018
Popliteal artery branches: Anterior tibial artery becomes dorsalis pedis artery of foot.Posterior tibial artery.Peroneal artery.
Percutaneous intervention for infrapopliteal occlusive disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Sarah E.B. Strot, Robert F. Cuff
A left lower extremity angiogram revealed diffuse atherosclerotic disease with the tibial vessels completely occluded. There was reconstitution of the anterior tibial artery via collaterals. Atherectomy and balloon angioplasty were completed successfully to more proximal vessels. Occlusion of the anterior tibial artery would not accommodate cannulation from an antegrade approach, so retrograde access of the anterior tibial artery was obtained with a micropuncture kit (Cook Medical Inc.). A V-18TM ControlWire guidewire (Boston Scientific Corporation, Marlborough, MA, USA) was used to cross the occlusion via a retrograde approach. This opened the origin of the anterior tibial artery and access was gained with a guidewire (Glidewire Advantage®; Terumo Medical Corporation) in an antegrade fashion. Angioplasty of the occluded segment was performed resulting in in-line flow to the foot via the anterior tibial artery (Figure7.1).
The Foot
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The anterior tibial artery enters the anterior compartment of the leg by passing between the tibia and fibula, above the proximal end of the interosseous membrane. It thereafter passes inferiorly through the compartment to the level of the ankle. As this artery crosses the ankle joint it is found to course with the deep peroneal nerve and is renamed the dorsalis pedis artery. The pulse of the dorsalis pedis is readily palpable in most individuals. From the dorsalis pedis arise medial and lateral tarsal branches, an arcuate branch (from which arise the lateral metatarsal vessels); a deep plantar branch, and a terminal first metatarsal branch.
Late lower extremity free flap vascular compromise and salvage in a Pediatric patient diagnosed with monophasic synovial sarcoma
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Shervin Zoghi, Kelsey Millar, Steven Thorpe, Christopher O. Bayne
The patient had a defect in her lower lateral leg and ankle measuring 12 cm by 5 cm with exposed peroneal tendons and anterior tibia and talus with minimal overlying periosteum and joint capsule (Figure 1). Even following soft tissue mobilization, given the size of the defect and the associated adiposity of other potential donor sites, the decision was made to perform a radial forearm fasciocutaneous free flap reconstruction. The radial forearm free flap measured 9 cm x 4 cm. An incision was made over the distal aspect of the anterior leg to dissect the recipient vessel (the anterior tibial artery). This incision was connected to the defect to allow for anastomosis without subcutaneous tunneling. The radial artery pedicle was anastomosed to the anterior tibial artery. The largest radial artery venae commitment was anastomosed to the largest venae comitant of the anterior tibial artery, and the cephalic vein was anastomosed to a large superficial vein of the anterior leg. A Doppler flow monitor probe was placed at the anastomoses site. The proximal and distal portions of the defect were approximated with 4-0 Nylon sutures in a horizontal mattress fashion and the flap was inset with interrupted simple 3-0 Monocryl sutures. The incision over the recipient's anterior tibial artery was closed with interrupted, simple 3-0 Monocryl sutures (Figure 2). A windowed short-leg splint was placed to allow for visual monitoring.
Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report
Published in Journal of Investigative Surgery, 2022
Wenhu Jin, Shusen Chang, Ziyang Zhang, Xiangkui Wu, Bihua Wu, Jianping Qi, Zairong Wei
A 15-year-old male was admitted to the department of oncology because of a right tibial Ewing’s osteosarcoma. After 6 courses of chemotherapy, he underwent tibial resection and implantation of an artificial prosthesis. Unfortunately, skin necrosis of the lower leg was accompanied by external exposure of the prosthesis. The anterior tibial artery was ligated during the operation; however, the posterior tibial artery was intact. Thus, a parallel cross leg free left lateral femoral artery descending branch of the lateral circumflex femoral artery flap and chimeric muscle flap was designed. The muscle flap was used to fill the wound cavity and the skin flap was used to cover the wound. A left medial sural artery propeller flap was prepared to wrap the vascular pedicle. A Kirschner needle was used to fix the legs. The time from the procedure to pedicle division was 19 days. At the 10-month follow-up the flaps had an excellent appearance and texture, and the left leg functioned normally (Figure 1).
The Adipo-Fascial ALT Flap in Lower Extremities Reconstruction Gustillo IIIC-B Fractures. An Osteogenic Inducer?
Published in Journal of Investigative Surgery, 2021
Mario Cherubino, Martina Corno, Mario Ronga, Giacomo Riva, Pietro G. di Summa, Davide Sallam, Federico Tamborini, Francesca Maggiulli, Michele Surace, Luigi Valdatta
All the flaps survived without any re-exploration (The results are summarized in Table 1). There were none vascular compromised. All patients were men. The mean time from injury to flap coverage was 72 hours (22 h–56h). The mechanisms of injury were motorbike accidents in all patients except for one case, who was involved in a job accident. At the time of injury, tibial nerve palsy was observed in one case. The mean size of the soft tissue defects before the operation was 50 cm2. The receiving vessels were the anterior tibial artery (end-to-end anastomosis) and posterior tibial artery (end-to-side anastomosis). None of the patients required vein grafting because of short pedicle length. In two patients the external fixator was kept the same kind till the end because were hybrid circular type. In other 3 cases, after the damage control period, internal fixation was used to allow a better quality of life of the patients. Solid bone union was reached, and full weight bearing present at 11 weeks (range 4–20) after the injury. All wounds healed without evidence of infection. An efficient bone union was reached at a mean of 6 months (range 2–10) after the injury and the lower limb was saved in 100% of the cases (Figure 8).