Anatomical Study of Vascularized Bone Harvested from the Posterior-medial Aspect of the Distal Tibia

Abstract

Background: The distal tibia is prone to open fracture with bone loss because of its anatomical characteristics. These injuries are commonly associated with complications such as non-union and bone necrosis. The pedicled vascularized bone flap harvested from the distal tibia is one of the alternative methods to overcome these complications. Methods: Seven fresh cadaveric lower extremities were dissected following injection of silicon compounds into the femoral artery. We investigated the number, location, and diameter of the nutrient communicating branches of the posterior tibial perforator and peroneal artery to the distal tibia. We elevated the bony flap (5 × 1 × 1 cm) from the medial distal tibia and measured the location it reached. Results: The mean number and diameter of nutrient branches to the tibia from the peroneal artery were 1 and 0.96 mm, respectively, and those from the posterior tibial artery were 1.1 and 0.83 mm, respectively. These branches constantly communicated and ran through the medial aspect of the distal tibia. The bony flap reached a mean of 16 cm from the proximal to distal edge of the medial malleolus. Conclusions: The posterior-medial aspect of the distal tibia was consistently nourished from communicating branches of the peroneal artery and posterior tibial artery. Vascularized bone grafts can be harvested from this region.