The anterior tibial artery gives perforating branches through the interosseous membrane and anterior ankle region to the dorsal foot skin, contributing to the angiosome of the anterior leg and dorsal foot flap territory.
The anterior tibial perforators are the vascular basis for anterior leg and dorsal foot perforator flaps used in reconstruction of lower leg wounds. The most consistent perforators are located 5-7 cm above the ankle joint. In severe ankle trauma, these perforators may be disrupted, threatening dorsal foot skin viability. The anterior tibial artery perforator flap is a reliable fasciocutaneous option for lower leg soft tissue reconstruction.
Loss of dorsal foot skin perfusion from anterior tibial perforator vessel injury in severe distal leg fractures, requiring early recognition and consideration of free flap coverage before zone of injury expands.
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