Cadaveric Study of Angiosomes of Anterior Tibial and Dorsalis Pedis Artery

Abstract

Introduction Angiosome formed by Anterior tibial artery and dorsalis pedis artery supply the ankle and the dorsum of foot. Both the vessels shows variation in termination and branching pattern.

Materials and Methods 50 free formalin preserved limbs were dissected for the study.

Results and Conclusion Anterior tibial artery showed variation in termination in 16%, most common of them was formation of loop with perforating branch of peroneal artery in 10%, bifurcation in to medial and lateral tarsal artery in 4% and trifutcation in 2%. Branching pattern of dorsalis pedis artey was variable in 18%, medial and lateral tarsal arteries were not branches of dorsalis pedis artery in 14% and 16% respectively. Arcuate artery was absent in 10%, when present it was branch of dorsalis pedis artery in 96%, perforating branch of peroneal artery in 2% and loop of medial and lateral tarsal artery in 2%. First dorsal metatarsal artery was not branch of dorsalis pedis artery in 4%. Lateral tarsal artery was constantly found in all the dissected limbs. Thorough knowledge of variation about branching pattern of arterial tree is clinically important for accuracy in interpretation of angiographs, Doppler study of lower limb vessels and optimum use of vascular pedicle for myocutaneous flaps. Importance of palpation of peripheral pulse in lateral tarsal artery is discussed in the study.

Keywords

dorsalis pedis artery - angiosome - vascular surgery - lateral tarsal artery - myocutaneous graft

• References

• 1 Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg 2006; 117 (7, Suppl) 261S-293S . Doi: 10.1097/01.prs.0000222582.84385.54
• 2 Swathi A. A morphological study of extensor digitorum brevis muscle of the foot in human cadavers. Banglore: Rajiv Gandhi University of Healthsciences. Dissertation; 2010: 95
• 3 Yamada T, Gloviczki P, Bower TC, Naessens JM, Carmichael SW. Variations of the arterial anatomy of the foot. Am J Surg 1993; 166 (02) 130-135 , discussion 135
• 4 Vijayalakshmi S, Gunapriya R, Varsha S. Anatomical study of dorsalis pedis artery and its clinical correlations. J Clin Diagn Res 2011; 5 (02) 287-290
• 5 Rajeshwari MS, Roshankumar BN. Vijayakumar. An anatomical study on dorsalis pedis artery. Inter J Anatom Research 2013; 1 (02) 88-92
• 6 Vasudha K, Ramesh BR. A morphological study of dorsalis pedis artery and its clinical correlation. J Pharm Biolog Sciences 2012; 2 (03) 14-19
• 7 DiLandro AC, Lilja EC, Lepore FL. , et al. The prevalence of the arcuate artery: a cadaveric study of 72 feet. J Am Podiatr Med Assoc 2001; 91 (06) 300-305
• 8 El Saeed EM, El Monsif AA, El Sayed MA, Aly NM, Gezlan NA. Anatomical study of the Dorsalis pedis artery and its surgical importance in reconstructive surgeries. Allexandria Bulletin 2008; 44 (02) 557-571
• 9 Lee JH, Dauber W. Anatomic study of the dorsalis pedis-first dorsal metatarsal artery. Ann Plast Surg 1997; 38 (01) 50-55
• 10 Gabrielli C, Olave E. Origins of dorsal metatarsal arteries in Humans. Scand J Plast Reconstr Surg Hand Surg 2008; 42 (04) 174-181
• 11 Tuncel M, Maral T, Celik H, Tasçioglu B. A case of bilateral anomalous origin for dorsalis pedis arteries (anomalous dorsalis pedis arteries). Surg Radiol Anat 1994; 16 (03) 319-323
• 12 Ali MW, Mohajir AM. Dorsalis pedis artery: variations and clinical significance. J Indian Med Assoc 1996; 94 (11) 417-418
• 13 Shetty SD, Nayak S, Kumar N, Abhinitha P. Hypoplastic anterior tibial artery associated with continuation of fibular (peroneal) artery as dorsalis pedis artery: a case report. Int J Morphol 2013; 31 (01) 136-139
• 14 Vijayalakshmi S, Varsha S. Double dorsalis pedis artery: a rare case report. Intern J Anatom Sciences 2010; 1: 37-38
• 15 Reich RS. The pulses of the foot: their value in the diagnosis of peripheral circulatory disease. Ann Surg 1934; 99 (04) 613-622
• 16 Legel K, Savard M, Blanco CJ, Jayanetti C. Dorsalis pedis aneurysm: a case report and review of the literature. J Foot Ankle 1998; 1 (11) 1
• 17 Hamada N, Ikuta Y, Ikeda A. Arteriographic study of the arterial supply of the foot. Surg Radiol Anat 1993; 15: 187-192
• 18 Kunnamo I. Doppler stethoscopy in diagnostics: evidence based medicine guidelines. Chap. 5. Chichester: John Wiley & Sons; 1993
• 19 del Piñal F, Herrero F. Extensor digitorum brevis free flap: anatomic study and further clinical applications. Plast Reconstr Surg 2000; 105 (04) 1347-1356
• 20 Aulivola B, Pomposelli FB. Dorsalis pedis, tarsal and plantar artery bypass. J Cardiovasc Surg (Torino) 2004; 45 (03) 203-212
• 21 Martin C, Saux P, Papazian L, Gouin F. Long-term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery. Chest 2001; 119 (03) 901-906
• 22 Neville RF, Attinger CE, Bulan EJ, Ducic I, Thomassen M, Sidawy AN. Revascularization of a specific angiosome for limb salvage: does the target artery matter?. Ann Vasc Surg 2009; 23 (03) 367-373
• 23 Chang H, Kwon SS, Minn KW. Lateral calcaneal artery as a recipient pedicle for microsurgical foot reconstruction. J Plast Reconstr Aesthet Surg 2010; 63 (11) 1860-1864
• 24 Zeng-Yuan S, Wei-Gang Y, Hai-Jiao M, Fa-Ke W, Yong-Sheng F. Applied anatomy of the island flap pedicled with lateral pedis dorsal artery chain. Chinese J Clin Anatom 2012; 30 (06) 609-611