Revisiting venous drainage of dorsum of foot for anatomical rationale behind venous ulcers, a cadaveric study.

Abstract

Background: The aim of this study was to study the venous drainage pattern of dorsum of foot and its anatomical variations with reference to the venous ulcer of foot. The objectives were to study its connection with the deeper structures and extensor retinaculum and to study the variations of its continuity with great saphenous vein (GSV) and short saphenous vein (SSV) at medial and lateral malleolus respectively.

Methods: The present study included 50 dorsum of feet specimens from embalmed adult cadavers. The skin thickness viz dermis and epidermis were measured using the digital Vernier callipers at three places, over the medial malleolus, lateral malleolus and over the dorsum mid foot.

Results: The midtarsal retinaculum is found in 4 specimens (8%) and one of the tributaries of DVA is found embedded in it. The sural and saphenous nerves were giving more than three (>3) cutaneous branches each at the lateral and medial malleoli in only 5 specimens (10%). The cutaneous branches from the deep peroneal nerve were observed and piercing the extensor retinaculum in only 2 specimens (4%). The double great and short saphenous veins were observed in 2 specimens each (4%), with a variable course of termination. The absence of great and short saphenous veins was observed in one specimen each (2%). The tributaries of GSV, SSV and DVA were piercing the extensor retinaculum in 5 specimens each (10%). The GSV and DVA were communication with the anterior tibial vein in only 5 specimens (10%).

Conclusions: Since venous drainage is least studied area, our study will bring the anatomical aspects to be studied to understand the probable aetiology and this will give way for future studies. The findings of this study may help in understanding the rationale behind the ulcer formation and its effective treatment.