Posterior Tibial Perforators

perforantes arteriae tibialis posterioris

The posterior tibial artery gives off fasciocutaneous perforators through the medial crural septum along the medial lower leg, supplying the skin of the medial leg from the knee to the ankle. These perforators emerge at consistent levels (proximal, middle, and distal thirds) and are the basis of medial leg fasciocutaneous flaps and the posterior tibial artery perforator (PTAP) flap.

Region: Lower Leg

Clinical Relevance

Clinical Notes

The posterior tibial perforators are mapped pre-operatively with handheld Doppler or CTA before medial leg flap surgery. The PTAP flap based on a single posterior tibial perforator provides thin, pliable skin for lower leg and ankle coverage without sacrificing the posterior tibial artery. In lower extremity reconstruction for open fractures, medial plantar artery flaps and posterior tibial perforator flaps are the primary local options for plantar heel and lower leg coverage. Pre-operative vascular assessment of the posterior tibial perforators is essential in diabetic and ischaemic patients.

Pathology

Common Injuries & Conditions

Posterior Tibial Artery Perforator Flap for Lower Leg Coverage

The PTAP flap based on a single posterior tibial perforator provides well-vascularised skin for medial lower leg and ankle coverage after open fracture or tumour resection; Doppler mapping locates the dominant perforator and CTA confirms posterior tibial artery patency before designing the skin paddle centred on the perforator.