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: Arterial pseudoaneurysm is a hematoma that is formed after damage to the arterial wall. We report a rare case of peroneal artery pseudoaneurysm after open reduction and internal fixation with interlocking nailing and partial fibulectomy for non-union for the right tibia in a 31-year-old male. The patient presented with a bleeding sinus over the leg swelling, and it was managed with an exploration of the pseudoaneurysm and ligation of the peroneal artery.
UNASSIGNED: A 30-year-old male patient presented with a non-union tibia on the right side and had undergone plating of the tibia at another institute for a fracture of both bone legs approximately 18 months ago. The revision surgery was performed in which a previously inserted implant was removed and an interlocking nail was inserted, along with a partial fibulectomy. The post-operative period was uneventful. At 8 weeks after the second surgery, the patient came with a complaint of swelling at the outer aspect of the right leg. Computed tomography and angiography confirmed a peroneal artery pseudoaneurysm of 3.2 × 2.8 × 3.8 cm. Pseudoaneurysm was explored, and the artery was overrun with a Figure-8 stitches using a monofilamentous, and non-absorbable suture.
UNASSIGNED: This case report highlights the occurrence of pseudoaneurysm after an orthoapedic procedure such as a partial fibulectomy. A high level of clinical suspicion, proper imaging, and early endovascular or surgical intervention is recommended to prevent complications.

The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.

In normal anatomy, the anterior tibial artery is typically the first branch of the popliteal artery before it becomes the tibioperoneal trunk. The normal course of the anterior tibial artery includes piercing through the interosseus membrane and continuing through the anterior compartment. It then continues onto the dorsum of the foot as the dorsalis pedis artery at the level of the malleoli. We describe a unique case of an anomalous origin of the dorsalis pedis artery from the peroneal artery. It is important for vascular surgeons to be aware of this variant while interpreting arteriograms of the lower extremity. It can be easily misinterpreted as an occluded distal anterior tibial artery with reconstitution of the dorsalis pedis artery from the collaterals.

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.

Surgical revascularization with distal bypass surgery is associated with good outcomes for chronic limb-threatening ischemia. The peroneal artery, the most-often preserved outflow vessel, is commonly reached through a lateral approach involving resection of the fibula. We present two different techniques for a lateral approach to the peroneal artery: the first by proximal exposure and the second by exposing the distal segment of the peroneal artery. Both techniques are performed without bone resection.

Bypass to the peroneal artery has sometimes been effective for pedal gangrene. However, the difficulty of approaching the terminal segment of the peroneal artery because of its anatomic features has been a clinical issue. Surgical access to this area can be achieved via a lateral approach with fibular resection. Although severe complications associated with fibular resection have rarely been reported, a less invasive surgical procedure would enable faster postoperative recovery and reduce the incidence of wound-related complications. We have described our experience with successful terminal peroneal artery bypass via a lateral approach without fibular resection in a 38-year-old male patient with chronic limb-threatening ischemia.

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.

OBJECTIVE: To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line.
METHODS: The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line).
RESULTS: The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (P<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (P>0.05).
CONCLUSIONS: The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.
目的: 总结腓肠神经营养血管皮瓣修复跖骨中点连线以远前足创面的临床经验，比较该皮瓣修复跖骨中点连线以远及以近创面的临床疗效。方法: 回顾性分析2002年4月至2020年4月间修复小腿中下段、踝及足部皮肤软组织缺损的425例腓肠神经营养血管皮瓣的临床资料。以跖骨中点连线为界，将腓肠神经营养血管皮瓣分为前足组(皮瓣最远端位于该连线以远的皮瓣)和踝周组(皮瓣最远端位于该连线以近的皮瓣)。结果: 前足组皮瓣部分坏死率(14.5%，10/69)高于踝周组(7.0%，25/356)，两组比较差异有统计学意义(P<0.05)。前足组和踝周组单独应用该皮瓣或联合简单二期处理覆盖创面的成功率分别为98.6%(68/69)和97.8%(348/356)，两组比较差异无统计学意义(P>0.05)。结论: 腓肠神经营养血管皮瓣是修复跖骨中点连线以远的前足皮肤软组织缺损的一种较理想的方法，该皮瓣修复跖骨中点连线以近创面的成活可靠性优于修复跖骨中点连线以远创面。.

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。.