Features of the Extraction of the Anterior Tibial Vessels in the Formation of Vascularized Bone Grafts

Abstract

Background. The currently existing techniques for dissection the anterior tibial vascular bundle in the proximal third of the lower leg do not provide sufficient length of the vascular pedicle to rotate the tibial bone graft to the level of the middle third of the thigh. The aim of the study to substantiate the possibility of pedicled transfer to the level of the thigh middle third of two blood-supplied bone autografts on a common permanent pedicle, including the anterior tibial vascular bundle. Material and Methods. The study was conducted on 62 lower limbs of non-fixed (native) corpses. We studied the topographic and anatomical relationship between the anterior tibial vascular bundle and the deep peroneal nerve at the level of the proximal third of the leg. Results. The distance between the tip of the greater trochanter of the femur and the distal edge of the anterior tibial bone graft using a combination of grafts at the same level in men was Me 176.7 [173.7; 193.9] mm, in women Me = 151.6 [146.9; 159.9] mm. An analysis of limb lengths ratios in men and women indicates standard level that can be achieved with graft rotation in each person. Conclusion. Dissection of the anterior tibial vascular bundle at the level of the proximal third of the lower leg allows rotation of the complex of the anterior tibial bone autograft and the autograft of the second metatarsal bone into the area of the middle third of the femur on a single vascular bundle. Prevention of injury to the deep peroneal nerve branches during dissection of the vascular pedicle requires the use of microsurgical techniques and preoperative preparation.