Sural flap vascularization in arteritic XXXX : an anatomic study of 24 amputation specimens.

@entity1 @entity4848 @entity4065 @entity455
Obliterating @entity4065 of the lower limbs is a classic contraindication for @entity4848 , particularly the sural flap. But recent literature reports examples of its successful application in arteritic @entity1 . The aim of this work was to study the vascular anatomy of the sural flap in @entity1 suffering from @entity4065 and its possible clinical application. Twenty-four specimens of leg amputation were studied. The mean age of the amputated @entity1 was 68.5 years. The clinical signs of @entity4065 had been present for 3-16 years. In 10 cases amputation was carried out directly, in 14 cases after failed revascularization. The results of the dissection showed the theoretical possibility of a sural flap in almost all the cases (23 of 24) despite certain anatomical peculiarities. In the upper part of the leg the arterial network of the sural communicating nerve dominates that of the sural nerve; this should allow the use of a sural flap centered on this @entity455 . In the lower part, the arterial network of the sural communicating nerve is sustained by the perforators of the peroneal artery, then by the branches of the calcaneal artery, and finally by the lateral tarsal artery, which should allow the use of a sural flap with a very distal pedicle. The authors propose a theory which suggests that the progressive @entity4065 and the concomitant development of a supply network involving the vascularization of the sensory nerves induces the "anticipation" of a sural flap.
