An Anatomical Study on Dominant Vascular Pedicle of Tibialis Anterior Muscle and its Implication on Tibialis Anterior Muscle Flap

Abstract

Background: The tibialis anterior muscle flap (TAMF) is a reliable option to provide coverage for the middle third of the leg. Identification of multiple segmental vessels for the TAMF often proves to be a tedious procedure. A single dominant vascular pedicle, if identified, can be consistently used for harvesting the TAMF. There are no anatomical studies in the literature that propose to identify the main vascular pedicle of the tibialis anterior muscle, which can be consistently used for transfer.

Materials and methods: Forty lower limbs of 20 cadavers were used for the study. Microdissection of the limbs was done to identify the tibialis anterior muscle and the vessel along their entire length. The number of vascular pedicles and the location of each pedicle from the knee joint line and tibial tuberosity were noted.

Results: There were a mean of 7.45 (minimum: 5; maximum: 9) segmental perforators from the anterior tibial artery. The average diameter of the dominant perforator was 1.10 ± 0.12 mm. The mean distance of the dominant pedicle from the knee joint line and the tibial tuberosity was 12.15 ± 0.98 and 7.7 ± 1.8 cm, respectively.

Conclusion: The dominant vascular pedicle of the tibialis anterior muscle is consistently found at an average distance of 12 cm from the knee joint line and 7.5 cm from the tibial tuberosity. The dominant pedicle could perfuse about 70% of the muscle bulk. A partial TAMF can be devised based on this dominant pedicle for middle one-third leg defects.

Keywords: TAMF; dominant vascular pedicle; function sparing; tibialis anterior.

Fig. 1

A dissected cadaveric specimen showing the tibialis anterior (TA) muscle with the seven perforators ( white arrows ) arising from the anterior tibial artery (ATA). Measurement of the distance of the perforators from the tibial tuberosity and the knee joint line done with a ruler.

Fig. 2

A digital caliper used for measuring the diameter of the vascular pedicle.

Fig. 3

( A ) Specimen of the tibialis anterior (TA) muscle with the anterior tibial artery (ATA). An infant feeding tube is inserted into the ATA and ligated distal to the dominant pedicle. ( B ) Fluoroscopic image showing significant muscle tissue perfused by the dominant vessel.

Fig. 4

( A ) Blood supply of the tibialis anterior muscle. ( B ) Amount of muscle perfused on fluoroscopy. ( C ) Possibility of muscle flap based on the dominant pedicle.