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Lower Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The anterior tibial artery crosses the ankle joint, and its name changes to dorsalis pedis artery that supplies the dorsum of the foot. It gives rise to the arcuate artery that in turn gives rise to the dorsal metatarsal arteries (Plate 5.9). The dorsalis pedis artery also gives rise to the lateral tarsal artery—which joins the lateral end of the arcuate artery to complete an arterial arch—and to the deep plantar artery—which passes between the 1st and 2nd metatarsal bones to enter the sole of the foot to form an anastomosis with the deep plantar arch formed mainly by the lateral plantar artery (Plate 5.16). The lateral plantar artery arises, together with the medial plantar artery, from the posterior tibial artery, and gives rise to the deep plantar arch that in turn gives rise to common and proper plantar digital arteries. Lastly, the fibular artery runs on the posterior side of the leg to give rise to the perforating branch of the fibular artery, which pierces the interosseus membrane just above the ankle joint to anastomose with the anterior tibial artery (Plate 5.11).
Peripheral vascular angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The idea of selective angiography revolves around advanc- ing a catheter to the limb in question. We generally create a road map to advance the catheter over a wire (Figure 25.26). Catheters utilized may include the Omni, Rim, Judkins right, Multipurpose, Navicross, Glide, and Traiblazer, to name a few. As an open-end catheter, we recommend mak- ing sure that the waveform with pressure is assessed. We usually recommend 12 cc contrast injection with 6 cc/s for 2 seconds. An AP projection is adequate for the SFA and pop- liteal. To image the tibial vessels, we recommend an ipsilat- eral view at 30° (Figure 25.19). For plantar vessels, a lateral view will identify the anterior and posterior circulation ves- sels. If an AP view is necessary, the foot is maintained in a natural orientation with slight dorsiflexion. The detector will be rotated with a cranial angle at 30°-40°. This view will show the distal DP artery as it connects into the tarsal branch (Figure 25.20). A lateral view of the foot will allow the operator to see the connection between the anterior circulation (i.e., dorsalis pedis) and the posterior circula- tion (i.e., lateral plantar artery) (Figure 25.21). This image is obtained by placing the detector in a parallel plane against the medial surface of the foot.
The Foot
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The lateral plantar artery, the larger terminal branch of the posterior tibial artery, passes with the deep branch of the lateral plantar nerve medially and deep across the sole, forming a deep plantar arterial arch. From this arch metatarsal and perforating branches arise, the metatarsal branches giving origin to plantar digital vessels and the perforating arteries linking the deep arch to the dorsal metatarsal vessels. The terminal portion of the arch is completed by an anastomosis with the plantar branch of the dorsalis pedis artery.
Reconstruction of the distal lower leg and foot sole with medial plantar flap: a retrospective study in one center
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Zheng-Qiang Cang, Xiao-Dong Ni, Yuan Xu, Min Wang, Qian Wang, Si-Ming Yuan
The pedicle is constituted by the medial plantar artery and its venae comitantes and the cutaneous branch of the medial plantar nerve [23–25]. The medial plantar artery is not the dominant blood supply source of the plantar, and it plays a relatively minor role in the blood flow of the foot because the blood flow of the deep plantar arch mainly comes from the lateral plantar artery and branches of the dorsalis pedis artery [20]. This artery’s sacrifice will not affect the prognosis of the plantar. On the other hand, the medial plantar artery has sufficient diameter to ensure good blood supply of the flap [23]. Thus, we removed the superfluous soft tissue and got a slender vascular pedicle that had a high flexibility to rotate the flap. No flap had difficulty in rotation during the operation, even though some of the patients had the distal lower leg defect. No patient complained of bloated pedicle after operation. This advantage is particularly evident in the repair of distal lower leg defect when compared with sural flaps. Herlin, in his study of patients who underwent ankle defect reconstruction using the sural flap, reported a major ankle bulking [11].