Background: An improved understanding of the extraosseous and
intraosseous blood supply of the distal aspect of the tibia, distal aspect of
the fibula, cuboid, and cuneiforms should identify vascular territories that
would enable surgeons to perform rotational vascularized pedicle bone-grafting
procedures in the foot and ankle.
Methods: We investigated the blood supply of twenty cadaveric lower
extremities using two vascular injection techniques. In order to define the
extraosseous and intraosseous arterial anatomy in this region, ten specimens
were sequentially subjected to injection with Batson's compound, soft-tissue
digestion, and bone-clearing according to a modified Spalteholz technique. To
further characterize the extraosseous vascular anatomy, the other ten
specimens were injected with latex and dissected.
Results: We identified a consistent and previously unnamed blood
supply to the distal aspect of the tibia, distal aspect of the fibula, cuboid,
and cuneiforms. Four vessels, each present in all of our specimens, provided
distinct vascular territories to bone. A branch of the proximal lateral tarsal
artery supplied a consistent vascular territory in the cuboid with an average
of fifteen nutrient vessels. Similarly, a branch of the distal medial tarsal
artery to the first cuneiform supplied an average of nine nutrient vessels
superior to the tibialis anterior tendon insertion. A branch of the anterior
lateral malleolar artery to the fibula supplied an average of seven nutrient
vessels to the lateral malleolus. A branch of the distal lateral tarsal artery
provided the midsection of the third cuneiform with an average of seven
nutrient vessels. In the latex-injected specimens, harvesting of the
vascularized pedicle bone grafts designed from these data demonstrated their
anatomic plausibility and arcs of rotation.
Conclusions: Four new rotational vascularized pedicle bone grafts
have been identified in the foot and ankle. These grafts were present in all
of our specimens, were well vascularized, had wide arcs of rotation, and were
relatively easy to harvest.
Clinical Relevance: These new rotational vascularized pedicle bone
grafts should enhance the ability of the surgeon to treat a variety of
problems in the foot and ankle.