THE SURGICAL ANATOMY OF THE PRINCIPAL NUTRIENT VESSEL OF THE TIBIA

Large segmental long-bone defects deserve consideration for reconstruction by vascularized, straight, high-density cortical bone grafts of comparable diameter. If available, the tibial diaphysis would be an option superior to the fibula, since the latter has known limitations when a large size discrepancy exists at the recipient site. However, the former choice is unrealistic except in the most unusual circumstances, since the tibia is a nonexpendable bone required for weight bearing. In anticipation of just such a unique opportunity, we have investigated the surgical anatomy of the principal nutrient vessel of the shaft of the tibia in 53 fresh lower limb specimens. Classical descriptions of the pertinent vascular anatomy of the tibial shaft are inadequate, since the origin of its principal nutrient vessel actually may be from the popliteal bifurcation or anterior or posterior tibial vessels. In every dissection at least a single artery and vein of large caliber (both exceeding 1.5 mm in diameter in 85 percent of cadavers) were discovered entering a nutrient foramen, usually at the upper third of the tibia. Lead oxide injection studies of the nutrient artery alone in nine cadavers demonstrated no contiguous muscle or cutaneous communications. The large size of these nutrient vessels would simplify ipsilateral pedicled transfers of an autologous tibial shaft as well as facilitate microanastomoses for its distant transfer to other humeral, femoral, or contralateral tibial defects as in a salvage replantation. Once immunologic barriers have been conquered, these data should have even greater practical clinical significance for the use of vascularized tibial allografts for substitution in lieu of autogenous fibula or other conventional bone donor sites.