The distal medial perforators of the lower leg and their accompanying veins

The skin of the lower leg is nourished by a number of perforating vessels arising from the named arteries which travel in the longitudinal axis of the limb. The distribution of these perforating arteries has been elucidated using a combination of techniques but which are essentially based on cadaveric studies. Clinically, this knowledge has provided the basis for methods of local tissue transfer in the lower limb. A common finding with the use of local fasciocutaneous flaps is venous congestion. The relationship of the veins to the arteries in perforating vessels of the lower limb has not been investigated. We studied the veins accompanying these arteries by dissecting them in 40 lower limbs (20 cadavers). A total of 40 pedicles were dissected. We concentrated our analysis of the arterial/venous relationship on the most distal vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used distally based fasciocutaneous flap). We found that 25 of these arteries were accompanied by one perforating vein whereas 12 were accompanied by two or more veins. When there was a single vein this was usually larger than the artery in external diameter and lay inferior to the artery 76% of the time. When there were two veins or more, there was an interconnection between the two around the artery in over half of the samples (7/12). Surprisingly, three vessels did not have any accompanying vein. This study sheds some light on the variation in venous drainage important to the initial survival of these flap transfers.