Reliability of the split tibialis anterior muscle flap for tibial shaft coverage: a cadaveric injection study.

Abstract

The vascular perfusion of a split tibialis anterior muscle (TAM) flap has not been specifically investigated. This cadaveric study was performed to evaluate the anatomical reliability of a split TAM flap using thermographic assessment and contrast injection. Five paired fresh-frozen cadaveric lower-extremity specimens were included. A split TAM flap was elevated using a design of longitudinal lateral split with a medial muscular hinge. Flap dimensions were recorded. Heated water was injected through the popliteal artery, followed by thermographic assessment using a thermal imaging camera. Subsequently, contrast medium was injected, and the number of intramuscular perforators supplying the split flap was evaluated. The mean flap dimension was 3 × 13.5 cm² (range, 2.5-4 × 12-15 cm²). Thermographic assessment demonstrated a mean temperature difference of 18.6 °C between pre- and post-injection measurements. Following contrast injection, a mean of 4 intramuscular perforators was identified within each split TAM flap (range, 3-5). The split tibialis anterior muscle flap demonstrates reliable vascular perfusion and represents a viable anatomical option for coverage of narrow anteromedial defects of the tibial shaft.