BACKGROUND: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries.
METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant.
RESULTS: The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury.
CONCLUSIONS: Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

UNASSIGNED: Vascularised fibular bone grafting is widely used in many reconstructive surgeries to repair bony defects. It is very essential for the nutrient blood supply to be conserved in the vascular bone graft. Understanding the sexual differences of the fibular nutrient foramen can help operating surgeons make appropriate changes in their clinical methodologies according to the sex. The present study was done to evaluate the sexual dimorphism of fibular nutrient foramen and its clinical importance in the adult central Indian population.
UNASSIGNED: This descriptive cross-sectional study was done on 136 dry adult central Indian human fibula bones of known sex (male: 68 and female: 68). The presence of nutrient foramen, their numbers, relation with fibular surfaces, and distance from the styloid process were assessed and were then clinically correlated.
UNASSIGNED: In males, single-nutrient foramen and double-nutrient foramina were seen in 92.65% and 7.35% of fibula, respectively. Whereas in females, single-nutrient foramen and double-nutrient foramina were seen in 95.59% and 4.41% of fibula, respectively. The position of the nutrient foramen and the fibular length showed significant sexual variation.
UNASSIGNED: This study concludes that among both sexes, the single fibular nutrient foramen in the middle third segment was the most prevalent. Compared to the female population, the male population demonstrated a broader location of the nutrient foramen.

UNASSIGNED: The goal of this study was to investigate the anatomy of the perforators from the peroneal artery in Vietnamese patients.
UNASSIGNED: 30 cadaver\'s legs were dissected and investigated for the distribution, course, origin, number and types of perforators of the peroneal artery. The locations of the exit points on the skin of perforators were marked in relation to reference points and segments.
UNASSIGNED: The total number of cutaneous perforating branches of the peroneal artery from 30 specimens was 149, which included 63 (42.2%) musculocutaneous perforators and 86 (57.8%) septocutaneous perforators. In most cases, the perforator branches were located in the range from 4 to 7 of the total fibula length (69.8%). The average number of perforating vessels in a leg was 4.9, ranging from 1 to 8 vessels. All the perforators were positioned behind the posterior border of the peroneal bone. In all the dissected samples presented, there was always one cutaneous perforator within a distance of 18 mm from the F point, which is the junction between the 6/10 and 7/10 segments at the posterior border of the fibular bone.
UNASSIGNED: The abundance of cutaneous perforators in Vietnamese patients can be used to plan various combined skin and bone flaps. A cutaneous perforator was consistently found near the F point, and this factor can be used in the planning of a bone flap with accompanying skin for monitoring survival of the underlying fibular bone flap.

UNASSIGNED: To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect.
UNASSIGNED: The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly.
UNASSIGNED: The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score.
UNASSIGNED: The peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.
UNASSIGNED: 基于下肢动脉造影图像探讨腓动脉穿支嵌合组织瓣修复小腿及足跟部复合缺损的可行性，并临床应用观察疗效。.
UNASSIGNED: 以2011年5月—2014年10月期间符合标准的50例患者下肢动脉数字减影血管造影图像作为研究对象，观察腓动脉走行及其穿支血管情况。基于观测结果，2015年4月—2020年10月设计腓动脉穿支嵌合组织瓣修复7例小腿及足跟部复合缺损。其中，男5例，女2例；年龄25～55岁，平均38岁。致伤原因：交通事故伤4例，高处坠落伤2例，机器绞伤1例。小腿皮肤及胫骨缺损5例，小腿皮肤缺损范围5 cm×3 cm～11 cm×7 cm，胫骨缺损长度5～8 cm。足跟部皮肤及跟骨缺损2例，足跟皮肤缺损面积5.0 cm×4.0 cm、7.5 cm×6.5 cm，跟骨缺损面积3.0 cm×2.6 cm、4.0 cm×3.0 cm。小腿缺损者切取皮瓣范围为6 cm×4 cm～12 cm×8 cm，腓骨长度与胫骨缺损长度一致；足跟部缺损者皮瓣面积为8.5 cm×5.5 cm、13.0 cm×5.0 cm，切取腓骨长度10、12 cm；游离移植5例，带蒂移位2例。供区游离植皮修复或直接拉拢缝合。.
UNASSIGNED: 影像学观测示腓动脉于腓骨头下方7.25～8.40 cm贴紧腓骨走行，并发出5～7支穿支血管，平均6.5支。穿支血管主要出现在4处，分别为距腓骨头下方（9.75±0.91）、（13.21±0.74）、（18.15±1.22）、（21.40±0.75）cm处，出现率分别为94%、90%、96%和88%。临床应用7例腓动脉穿支嵌合组织瓣全部成活，创面Ⅰ期愈合；供区植皮均成活，切口Ⅰ期愈合。患者均获随访，随访时间6～36个月，平均 12个月。腓动脉穿支嵌合组织瓣外形良好、质地柔软；X线片复查示植骨均愈合良好，愈合时间6～11个月，平均7个月；随访期间未见明显骨吸收。5例患肢行走无疼痛，1例轻度疼痛伴跛行；1例术后足跟溃疡形成，穿定制足底压力分散鞋后溃疡愈合。术后6个月，按照Holden步行功能评分标准，Ⅳ级2例、Ⅴ级5例。.
UNASSIGNED: 腓动脉穿支血管分布恒定，采用腓动脉穿支嵌合组织瓣修复小腿及足跟部复合缺损安全，可获得较好疗效。.

BACKGROUND: The frequency of appearance of anatomical variability in the terminal division of the popliteal artery (PA) is different according to the type of sample used, and ranges from 2% to 21%. The PA locates 1,01 cm behind to the lateral meniscus, which makes it vulnerable during surgical procedures. Iatrogenic injury of the PA or its terminal branches increases if anatomical variables are present. Our aim was to describe and review the branching pattern of the PA in a body-donors to science sample to determine the influence of the sample used (body-donors vs imaging test).
METHODS: A sample consisting of 260 popliteal regions, corresponding to 130 corpses (66 women, 64 men), have been dissected. Multivariate analysis was carried out.
RESULTS: The terminal division of the PA was classified as follows: Pattern 1: the PA divided into the anterior tibial (ATA) and the posterior tibial arteries (PTA) at the level or distal to the lower border of the popliteal muscle (PM) (94.7%). Pattern 2: the PA bifurcated into the ATA and PTA, proximal to the lower border of the PM (3.3%). Pattern 3: the PA divided at the same level into the ATA, PTA and PEA. (2%). No significant differences between gender and side of the limb could be find.
CONCLUSIONS: We propose a classification that encloses three identifiable groups only. This will allow clinicians to bear in mind these variables easily, at the same time avoiding injuries during surgical procedures such as lateral meniscus repair.

BACKGROUND: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size.
METHODS: Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde-retrograde approach. Patient factors and flap factors were compared between the \"survival\" and \"partial necrosis\" groups.
RESULTS: Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).
CONCLUSIONS: The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing the ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

OBJECTIVE: To report a subgroup analysis of the prospective, multicenter, single-arm DEFINITIVE LE trial to assess the effectiveness of directional atherectomy for the treatment of infrapopliteal artery lesions at 1 year.
METHODS: In the DEFINITIVE LE trial, follow-up assessments occurred up to 1 year postprocedure. Of the 800 patients enrolled, 145 subjects with 189 infrapopliteal lesions met the criteria for this analysis. Seventy (48.3%) and 75 (51.7%) patients were suffering critical limb ischemia (CLI) and intermittent claudication, respectively; 68.3% (99/145) had diabetes. The mean lesion length was 58±44 mm (all lesions); 20.2% were occluded. The primary endpoint for patients with claudication was duplex ultrasound-derived primary patency, while for subjects with CLI it was freedom from major amputation of the target limb at 1 year. Endpoints and adverse events were independently assessed.
RESULTS: Procedure success (≤30% residual stenosis) was achieved in 84% of treated lesions. The 1-year primary patency rate was 84% (claudicants 89.6% and CLI patients 78%, p=0.11), and the freedom from major amputation rate was 97.1% (claudicants 100% and CLI 93.8%, p=0.03). In both claudication and CLI patients, significant improvements in Rutherford category and objective measures of walking distance and quality of life were seen at 1 year in comparison to baseline.
CONCLUSIONS: This study demonstrates that directional atherectomy in infrapopliteal arteries results in promising technical and clinical results at 1 year for claudicant as well as CLI patients.