Three-dimensional computed tomographic angiographic study of the inter-perforator flow of the lower leg.

Background: The area perfused by a single perforator depends on its perforasome and its unique inter-perforator flow pattern. The purpose of this study was to clarify the inter-perforator flow patterns of the peroneal and posterior tibial artery perforators (PA-Ps, PTA-Ps) using three-dimensional computed tomographic angiography (3D-CTA). Methods: Thirteen whole leg skin flaps were harvested in the subfacial plane from fresh cadavers. PA-Ps, PTA-Ps, anterior tibial, and sural artery perforators (ATA-Ps, SA-Ps) with a diameter greater than 0.5 mm were documented. 3D-CTA with an injection of iodinated contrast medium into the PA-P or PTA-P was used to investigate the percentages of the area and the perforators that were perfused. Results: The mean percentage of the total area perfused by a PA-P was 42.0% and by a PTA-P was 38.0% (p = 0.084). The mean percentage of the total perforators perfused by a PA-P was 55.0% and by a PTA-P was 44.2% (p = 0.004). While the mean percentages of same-source artery perforators perfused by a PA-P (73.6%) and by a PTA-P (77.2%) did not differ (p = 0.513), the mean percentages of other-source artery perforators perfused by a PA-P (49.9%) and by a PTA-P (32.3%) were significantly different (p

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