Anatomical considerations of the deep peroneal nerve for biopsy of the proximal fibula in Thais

The present research aims to study the anatomical relationship between the deep peroneal nerve and the neighboring structures in the proximal fibula of Thais, with special regard to define the boundaries of a “safe” area when performing a biopsy of the proximal fibula. The proximal parts of 118 legs of 59 formalin‐embalmed adult cadavers (31 males, 28 females) were investigated. The distance from the apex of the fibular head to the point of origin of the deep peroneal nerve, the distance from the most lateral prominence of the fibular head to the anterior intermuscular septum, and the angle between the deep peroneal nerve and the fibula axis were measured. The results showed that the mean distances from the apex of the fibular head to the point of origin of the deep peroneal nerve was 28.4 ± 4.8 mm and from the most lateral prominence of the fibular head to the anterior intermuscular septum was 14.9 ± 2.0 mm. The mean angle between the deep peroneal nerve and the fibular axis was 28.1° ± 7.2°. In conclusion, these findings suggest that a “safe” area for bone biopsy in the proximal fibula of Thais is palpable anterior to the fibular head and downward laterally, not lower than 28 mm or 8% of the fibular length and from the most lateral prominence transverse medially not further than 14 mm. The inferior boundary of this area is an oblique line of the deep peroneal nerve about 28° from the fibular axis. Clin. Anat. 22:256–260, 2009. © 2008 Wiley‐Liss, Inc.     

Anatomy of the superficial peroneal nerve related to the harvesting for nerve graft

The superficial peroneal nerve (SPN) is one of the two main branches of the common peroneal nerve, which become cutaneous nerve on the lateral side of distal leg and dorsum of foot. The use of SPN as nerve graft has been introduced; however, important data regarding the morphometric anatomy of this nerve and its branches, medial and intermediate dorsal cutaneous nerves (MDN and IDN, respectively) to support this application remain incomplete. Eighty-five legs of cadavers were dissected and the branching pattern was classified into Type 1 (penetration of the main trunk of SPN from the deep fascia) or Type 2 (separate penetration of the MDN and IDN). The length of SPN, MDN and IDN from the penetration points until before subsequent branching was measured. In addition, the penetration points were located by referring to the intermalleolar line and the lateral malleolus. Type 1 was found in the majority of specimens independent of gender (71.8%). Asymmetry in the branching pattern was observed in nine cases (20.9%). The average length of the SPN, MDN and IDN without branches was 7.7, 8.1 and 5.5 cm, respectively. The penetration points of the SPN, MDN and IDN were located 5.1, 7.6 and 5.5 cm above the intermalleolar line, respectively. These data are important for using the SPN as a graft.     

Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus

The aim of this study was to investigate the risk and to analyse the significance of laceration of the sural and superficial fibular nerves during the surgical approach to the lateral malleolus. The sural and the superficial fibular nerves, and their branches were dissected under ×3 magnifying lenses in 68 embalmed leg‐ankle‐foot specimens. The specimens were measured, drawn and photographed. In 35% of specimens the superficial fibular nerve branched before piercing the crural fascia, and in all these specimens the medial dorsal cutaneous nerve of the foot was located in the anterior compartment while the intermediate dorsal cutaneous nerve of the foot was located in the lateral compartment. In 35% of specimens the intermediate dorsal cutaneous nerve of the foot was absent or did not innervate any toe. The deep part of the superficial fibular nerve was in contact with the intermuscular septum. Its superficial part was parallel with the lateral malleolus when the nerve pierced the fascia more proximally and oblique to the lateral malleolus when the nerve pierced the fascia distally. In one case the intermediate dorsal cutaneous nerve of the foot was in danger of laceration during a subcutaneous incision to the lateral malleolus. In 7 cases (10%) the sural nerve overlapped or was tangent to the tip of the malleolus. Malleolar nerve branches were identified in 76% of the cases (in 28% from both sources). The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. Our study indicates that during the approach to the lateral malleolus there is a high risk of laceration of malleolar branches from both the sural and the superficial fibular nerves. There is less risk of damage to the main trunk of these nerves, but the 10% chance of laceration of sural nerve at the tip of the malleolus is significant. As the sural nerve supplies the superficial innervation to the lateral half of the foot and toes in 40% of cases, the risk of its laceration is even more important than indicated by the common anatomical teaching.     

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures

The facial nerve is responsible for any facial expression channeling human emotions. Facial paralysis causes asymmetry, lagophthalmus, oral incontinence, and social limitations. Facial dynamics may be re‐established with cross‐face‐nerve‐grafts (CFNG). Our aim was to reappraise the zygomaticobuccal branch system relevant for facial reanimation surgery with respect to anastomoses and crossings. Dissection was performed on 106 facial halves of 53 fresh frozen cadavers. Study endpoints were quantity and relative thickness of branches, correlation to “Zuker's point”, interconnection patterns and crossings. Level I and level II branches were classified as relevant for CFNG. Anastomoses and fusion patterns were assessed in both levels. The zygomatic branch showed 2.98 ± 0.86 (range 2–5) twigs at level II and the buccal branch 3.45 ± 0.96 (range 2–5), respectively. In the zygomatic system a single dominant branch was present in 50%, two co‐dominant branches in 9% and three in 1%. In 66% of cases a single dominant buccal twig, two co‐dominant in 12.6%, and three in 1% of cases were detected. The most inferior zygomatic branch was the most dominant branch (P = 0.003). Using Zuker's point, a facial nerve branch was found within 5 mm in all facial halves. Fusions were detected in 80% of specimens. Two different types of fusion patterns could be identified. Undercrossing of branches was found in 24% at levels I and II. Our study describes facial nerve branch systems relevant for facial reanimation surgery in a three‐dimensional relationship of branches to each other. Clin. Anat. 32:480–488, 2019. © 2019 Wiley Periodicals, Inc.     

The cubital tunnel: a radiologic and histotopographic study

Entrapment of the ulnar nerve at the elbow is the second most common compression neuropathy in the upper limb. The present study evaluates the anatomy of the cubital tunnel. Eighteen upper limbs were analysed in unembalmed cadavers using ultrasound examination in all cases, dissection in nine cases, and microscopic study in nine cases. In all cases, thickening of the fascia at the level of the tunnel was found at dissection. From the microscopic point of view, the ulnar nerve is a multifascicular trunk (mean area of 6.0 ± 1.5 mm²). The roof of the cubital tunnel showed the presence of superimposed layers, corresponding to fascial, tendineous and muscular layers, giving rise to a tri‐laminar structure (mean thickness 523 ± 235 μm). This multilayered tissue was hyperechoic (mean thickness 0.9 ± 0.3 mm) on ultrasound imaging. The roof of the cubital tunnel is elastic, formed by a myofascial trilaminar retinaculum. The pathological fusion of these three layers reduces gliding of the ulnar nerve during movements of the elbow joint. This may play a role in producing the symptoms typical of cubital tunnel syndrome. Independent from the surgical technique, decompression should span the ulnar nerve from the triceps brachii muscle to the flexor carpi ulnaris fascia.     

The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants

Procedures involving the small saphenous vein (SSV) can result in sural nerve (SN) damage due to the proximity of the two structures. The relationship between the SN and SSV has previously been described in cadaveric studies with limited scope on surface landmarks. This study investigates the relationship between the SN and SSV in vivo through ultrasound. Transverse/short‐axis ultrasound scans of 128 legs (64 healthy participants) were taken by a single observer using a GE Logiq e ultrasound system with a 5–13 Hz linear transducer (GE Logiq 12L‐RS). The SN was identified and traced from the lateral malleolus to the popliteal fossa noting its course and proximity to the SSV. The distance between the SN and SSV was measured at points representing the distal 50% and 25% of the total leg length (the distance between the medial tibial condyle and the inferior edge of the medial malleolus). The SN and SSV were visualized in all participants regardless of BMI and atypical anatomical relationship were noted in 20.3%. The SN pierced the fascia in the distal 25.9% ± 5.3% of the total leg length. The distance between the SN and SSV was 4.06 ± 1.8 mm and 3.4 ± 1.4 mm in the distal 50% and 25% points of the total leg length, respectively. There was no significant effect of sex or body side. The SSV is a viable option for multiple vein harvest. Ultrasound visualization can be a beneficial tool for delineating variations of the SN in relation to SSV prior to surgery. Clin. Anat. 32:277–281, 2019. © 2018 Wiley Periodicals, Inc.     

Navigation for ankle arthroscopy: anatomical study of the anterolateral portal with reference to the superficial peroneal nerve

We aimed to navigate the surgeon regarding the localization of the main anatomical structures at the anterior part of the ankle joint, in order to find easily the safest anatomical points with reference to the superficial peroneal nerve (SPN), in particular for anterolateral portal placement in ankle arthroscopy. Sixty-three ankles in 36 fresh cadavers were dissected. In all specimens we examined (1) the distance between the SPN bifurcation and the most distal point of the lateral malleolus; and at the level of ankle joint, (2) the number of SPN, (3) the distance between the medial and intermediate dorsal cutaneous nerves, which are branches of the SPN, (4) the localization of the peroneus tertius (PT) tendon in relation to the lateral malleolus, (5) the width of the extensor digitorum longus (EDL) tendon, (6) the relationship of the PT tendon and (7) the relationship of the extensor hallucis longus (EHL) tendon with the SPN. The results were as follows: (1) In 41 ankles with bifurcation (65%) the average distance was 71.8±35.3 mm. (2) There were two SPN branches in 39 (62%), three branches in seven (11%) and one branch in 17 (27%) cases. (3) In 39 ankles with two branches of the SPN, the mean distance was 15.2±7.1 mm. (4) The lateral border of the PT tendon was positioned a mean distance of 20.8±3.3 mm proximal and 25.2±5.8 mm medial to the reference points. (5) The mean width was 10.1±2.9 mm. (6) In 42 ankles (67%) the distance between the lateral border of the PT tendon and the SPN was a mean of 6.2±6.6 mm, median of 3 mm (range 0–22 mm lateral to the tendon). (7) In 56 cases (89%) a branch of the SPN was found a mean of 6.6±4 mm and a median of 6 mm lateral to the EHL tendon, and in seven cases (11%) on the tendon. According to our study, in ankle arthroscopy the risk of the SPN injury is maximal in the 0–3 mm lateral to the PT tendon. To avoid injury to the SPN, the safest placement of the anterolateral portal is 4 mm lateral to the PT tendon.     

股外侧皮神经在髂前上棘附近的解剖学和超声观察

目的 感觉异常性股痛(MP)常由股外侧皮神经(LFCN)的机械嵌压引起,通常发生在股外侧皮神经走行至髂前上棘的部位。MP最佳手术治疗方法有待确定,部分原因是LFCN周围筋膜平面的精细结构尚未阐明。本研究的目的是利用生物塑化和超声确定LFCN在髂前上棘附近的筋膜结构。方法 选择11具尸体（6名女性,5名男性, 38～97岁）制作薄层生物塑化切片。对34名健康志愿者（19名女性,15名男性,20～62岁）进行LFCN超声评估。结果 LFCN在腹内斜肌筋膜纤维和髂筋膜之间出骨盆,然后在缝匠肌表面和位于髂前上棘（ASIS）下方的阔筋膜张肌之间走行。在缝匠肌和阔筋膜张肌之间,LFCN走行在独立封闭的筋膜鞘中。结论 LFCN在髂前上棘处位于腹内斜肌腱膜内。LFCN在缝匠肌表面及外侧走行至大腿前外侧区域。超声定位LFCN有助于外科手术。     

外踝术中腓肠神经和腓浅神经的应用解剖

目的　探讨外踝术中腓肠神经和腓浅神经损伤的风险 ,并分析损伤后感觉缺失情况。方法　在解剖显微镜下对 5 0侧常规防腐固定成年尸体的腓肠神经和腓浅神经及其分支作解剖 ,观测和绘图。结果　 2 4 % (12侧 )的腓浅神经或足背中间皮神经浅出点在外踝前缘水平 ,10 % (5侧 )的腓肠神经横切过外踝尖 ,78% (39侧 )的标本可识别来自这两条神经的踝支 (其中 2 8%同时具有两个来源 ) ,腓肠神经管理 38% (19侧 )标本的足及足趾的外侧半。结论　外踝术中很容易损伤来自腓肠神经和腓浅神经的踝支 (可能性为 78% ) ,损伤神经主干的风险较小 ,但有 2 4 %的可能损伤在外踝前缘浅出的腓浅神经或足背中间皮神经 ,10 %的可能损伤外踝尖处的腓肠神经 ,而且损伤后感觉缺失范围差异很大 ,腓肠神经具有比解剖学以往描述的更重要的意义     

Detailed anatomy of the abducens nerve in the lateral rectus muscle

The aims of this study were to elucidate the detailed anatomy of the abducens nerve in the lateral rectus muscle (LRM) and the intramuscular innervation pattern using Sihler staining. In this cohort study, 32 eyes of 16 cadavers were assessed. Dissection was performed from the LRM origin to its insertion. The following distances were measured: from LRM insertion to the bifurcation point of the abducens nerve, from LRM insertion to the entry site of the superior branch or inferior branch, from the upper border of the LRM to the entry site of the superior branch, from the lower border of LRM to the entry site of inferior branch, and the widths of the main trunk and superior and inferior branches. The single trunk of the abducens nerve divided into two branches 37 mm from insertion of the LRM, and 22 of 32 (68.8%) orbits showed only two superior and inferior branches with no subdivision. The superior branch entered the LRM more anteriorly (P = 0.037) and the superior branch was thinner than the inferior branch (P = 0.040). The most distally located intramuscular nerve ending was observed at 52.9 ± 3.5% of the length of each muscle. Non‐overlap between the superior and inferior intramuscular arborization of the nerve was detected in 27 of 32 cases (84.4%). Five cases (15.6%) showed definite overlap of the superior and inferior zones. This study revealed the detailed anatomy of the abducens nerve in the LRM and provides helpful information to understand abducens nerve palsy. Clin. Anat. 30:873–877, 2017. © 2017 Wiley Periodicals, Inc.     

Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance

The lateral femoral cutaneous nerve (LFCN), a branch from the lumbar plexus, may come to the clinician's or surgeon's attention. We studied this nerve to determine its location and its relationship with neighboring structures around the anterior superior iliac spine (ASIS) and the inguinal ligament (IL). Additionally, cross‐sectional microanatomy of the LFCN at the IL was studied. The LFCN was dissected in 47 lower limbs from formalin‐fixed cadavers. The distances from the ASIS to the point where the LFCN crossed the IL and the lateral border of the sartorius were measured. The distance between the ASIS and the point it pierced the deep fascia was also measured. Twelve nerve specimens at the IL were collected for histological sectioning and were stained with hematoxylin and eosin. On examination of the cross‐sectional area, the nonfascicular area was wider than the fascicular area because of an increased amount of thick collagen fibers. This study may be of help to clinicians managing meralgia paresthetica and may also assist in defining a safe area for surgical intervention on the anterolateral aspect of the thigh. Clin. Anat. 23:978–984, 2010. © 2010 Wiley‐Liss, Inc.     

腓总神经与腓骨颈的关系及其小腿各肌支的解剖学研究

目的明确腓总神经与腓骨颈的关系以及小腿各肌支的解剖学特征。方法取成人下肢标本40例,在肉眼及放大镜下解剖,观察腓总神经与腓骨颈的关系以及腓总神经各肌支的数目及走行,以腓骨头最突出点为测量起点,测量腓总神经绕腓骨颈处至腓骨头最突出点的距离;测量各肌支的发出点、入肌点的高度,并作统计学分析。结果腓总神经绕腓骨颈处至腓骨头最突出点的距离,左、右侧分别为(1.64±0.36)cm和(1.58±0.34)cm。各肌支的数目不等,其中胫骨前肌支数目最多,腓骨短肌支和跗长伸肌支的数目较少。40例标本中,腓总神经均穿行于腓骨颈部骨一筋膜管。结论腓总神经在绕腓骨颈处均穿行于骨一筋膜管。提示:这可能是导致腓总神经卡压综合征的主要原因之一;不同肌肉的神经肌支数目差别较大,与其所支配肌肉的结构、功能有关。     

Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block

The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal and 13 adults) formolized cadavers were dissected. Distances were measured from the origin of the SN (passing under the piriformis muscle) to its division into TN and CPN, and from there to the popliteal crease. The sciatic/thigh coefficient (proportion relating SN length to thigh length) and the variation coefficient for the SN were calculated. The distance from the popliteal crease to the SN division was significantly shorter in neonates than in adults (1.04 ± 0.9 cm vs. 5.6 ± 5.1 cm, P = 0.0003). In addition, the neonatal SN divided at a proportionally more distal position in the thigh than it did in adults (86 ± 13 vs. 74 ± 15%, P = 0.0059). However, the coefficient of variation between the SN‐division distances was not statistically different in infants and adults (12.8 vs. 18.2%, P = 0.4345). The variations in the point of SN division seen in the adult SN are already seen in the neonatal period, but in newborns the SN divided in a more distal position in relation to the thigh than in adults, so this finding of anatomical variability in neonates suggests that ultrasound guidance can be useful when performing a SN block in these small patients.     

舌骨大角尖端周围血管神经的解剖学研究

目的为临床颈部手术以舌骨大角尖端(THB)为标志定位周围血管神经提供解剖学资料。方法在21例防腐罐注红色乳胶的成人头颈部标本上显露THB及其周围结构(颈总动脉分叉,甲状腺上动脉、舌动脉、舌下神经、喉上神经),通过THB做互相垂直的水平线和垂直线,测量相关结构与此两线间的距离。结果颈总动脉分叉点A位于THB后方8.5±2.3 mm,下方12.8±4.8 mm;甲状腺上动脉起点B位于THB后方4.6±2.2 mm,下方12.8±4.2 mm;舌动脉起点C位于THB后方4.1±2.5 mm,上方0.2±3.8 mm;其弓形最高点D位于THB前方0.2±2.1 mm,上方7.5±2.6 mm;舌下神经与垂直轴交点E位于THB上方5.1±1.6 mm;喉上神经内支与两轴的交点F、G分别距THB后方7.9±2.5 mm,下方6.5±2.0 mm。结论以THB为标志定位其周围血管神经有利于临床医生处理颈部的手术。     

Anatomic relationship of the radial nerve to the elbow joint: Clinical implications of safe pin placement

The percutaneous placement of lateral distal humeral pins risks injury to the radial nerve. We aimed to provide a reliable and safe parameter for the insertion of lateral distal humeral pins. A secondary aim of this study was to investigate the effect of pin/screw placement in the intended zone of fixation at the lateral distal humerus. We dissected 70 fresh cadaveric upper limbs and the radial nerve was identified and its course followed into the anterior compartment. The point where the radial nerve crosses humerus in mid lateral plane was identified and the distance between this point and lateral epicondyle was measured, as was the maximum trans‐epicondylar distance, along with the olecranon fossa height. Statistical analysis was performed using the Pearson correlation coefficient. The average trans‐epicondylar distance was measured at 62 ± 6 mm (range 52–78 mm), and the average lateral radial nerve height was 102 ± 10 mm (range 75–129 mm). The ratio of the lateral nerve height to the trans‐epicondylar distance was an average of 1.7 ± 0.2 (range 1.4–2.0). The Pearson correlation coefficient between the lateral nerve height and the trans‐epicondylar distance was r = 0.95. A relative dimension, the trans‐epicondylar distance is both reliable and easily accessible to the operating surgeon. The absolute safe zone for pin entry into the lateral distal humerus is that area lying within the caudad 70% of a line, equivalent in length to the patient's own trans‐epicondylar distance, when projected proximally from the lateral epicondyle. Clin. Anat. 22:684–688, 2009. © 2009 Wiley‐Liss, Inc.     

外踝及其周围结构的解剖学测量及临床意义

目的　对外踝及其周围结构进行解剖学观测,为外踝骨折内固定及设计外踝定位导向器提供解剖学基础。 方法　①80例（男20对,女20对）干燥腓骨下端形态进行观察分析;②40例（男20,女20）X线片观察外踝的大体形态;③40具（男20,女20）尸体解剖观测外踝前动脉、腓浅神经,腓肠神经毗邻关系。 结果　（1）外踝从上往下骨质逐渐均匀的变薄变窄,近似一个倒立的三角形;（2）骨性标本外踝左右两侧高度、宽度、厚度测量比较差异无统计学意义(P>0.05);但存在性别差异(P<0.05)。（3）男女X线片上外踝角测量比较差异无统计学意义(P>0.05);（4）外踝前动脉在距离外踝尖端平面男性(4.30±0.22)cm,女性(4.11±0.6)cm处由胫前动脉发出,先斜向外下方至腓骨下端;然后紧贴腓骨下端及外踝前缘进入足背。（5）腓浅神经主干距离外踝前缘男性(1.59±0.20)cm,女性(1.31±0.64)cm;腓肠神经经过外踝后外下方,距离外踝后缘男性(1.80±0.13)cm,女性(1.62±0.34)cm; 结论　外踝及其周围结构的解剖学测量结果为外踝骨折内固定以及设计外踝定位导向器提供解剖学基础。     

面神经阻滞入路相关结构的应用解剖

目的　探讨面神经阻滞入路相关结构的解剖关系 ,为面神经阻滞的进针入路和预防并发症的发生提供解剖学依据。方法　成年男性尸体 2 8具 (5 6侧 ) ,模拟面神经阻滞穿刺 ,用游标卡尺进行测量。结果　面神经阻滞穿刺点的位置为外耳道软骨下缘、乳突前缘和下颌支后缘的交汇处 ,垂直于正中矢状面进针 ,左侧深度为 19 91± 0 0 9mm ,右侧为 19 82± 0 10mm。结论　本研究确定了面神经阻滞准确的穿刺点、穿刺角度及深度 ,有利于麻醉药发挥作用以提高疗效。     

内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计

目的：为隐神经营养血管远端蒂皮瓣设计提出解剖学依据。方法：30侧经动脉灌注红色乳胶成年下肢标本，解剖观测内踝区动脉来源、分支、分布及吻合。结果：内踝区动脉有9个来源，构成3条纵向的血管网：(1)内踝前动脉和踝上支的前纵向血管网；(2)骨皮穿支的中纵向血管网；(3)胫后动脉肌间隙支和踝管动脉穿支的后纵向血管网。形成3个层面的血管网：(1)骨膜血管网；(2)深筋膜血管网；(3)皮神经浅静脉血管网。内踝区骨膜、筋膜、大隐静脉、隐神经和皮肤的营养血管同源。结论：内踝区血供来源为多源性，有明显的方向性，吻合十分丰富，可以设计3种包含浅深筋膜、皮神经、浅静脉及其营养血管的小腿内侧远端蒂皮瓣：(1)以胫后动脉肌间隙支为蒂，旋转轴点在内踝最凸出点上3cm；(2)以内踝前动脉筋膜穿支为蒂；(3)以踝管区动脉穿支为蒂，旋转轴点在内踝最凸出点平面。     

针刀治疗枕大神经卡压综合征的应用解剖研究

目的 力针刀治疗枕大神经卡压综合征提供形态学依据.方法在20侧成人尸体头颈标本上,对枕大神经的行径、穿斜方肌腱膜和深筋膜以及易发生卡压的部位进行了解剖、观察和测量.结果①枕大神经在枕外隆凸的下方2.8cm±0.2cm,旁开2.6cm±0.1cm处穿斜方肌健膜和深筋膜至皮下;③穿斜方肌腱膜和深筋膜的部位约位于枕外隆凸到乳突尖连线中、上1/3交界点;③穿出点有大量腱纤维和筋膜束缠绕枕大神经及枕动静脉,是发生卡压的部位.结论 用针刀在枕神经穿腱膜和筋膜点的稍内侧进针,从外上向内下作分离松解,便可解除其卡压.     

The lateral calcaneal artery: Anatomic basis for planning safe surgical approaches

The proximity of the lateral calcaneal artery (LCA) to surgical incisions applied to the lateral hindfoot makes it vulnerable to iatrogenic injury and subsequent postoperative skin necrosis. This study aimed to investigate the course of the LCA and to define anatomical points that can be used by surgeons during lateral approaches to the calcaneus. Thirteen leg‐ankle‐foot specimens were dissected and the superficial course of the LCA was outlined by three anatomic points: (a) tip of lateral malleolus, (b) the point where it pierces the deep fascia, and (c) the point where it crosses the line connecting the lateral malleoluswith the insertion of Achilles tendon. Fifteen healthy volunteers were investigated by color Doppler ultrasound where the diameter and depth of LCA were measured. The LCA pierced the deep fascia at a maximum height of 4.5 cm (mean 3.78) above the midpoint of a line extending from the lateral malleolus to the insertion of Achilles tendon. It crossed the previous line at a maximum distance of 3 cm (mean 2.6) posterior to lateral malleolus. At this point, its mean diameter was 1.75 mm on the right and 1.73 mm on the left sides, while its mean depth was 7.73 mm on the right and 8.0 mm on the left sides. A dangerous triangle that contained the superficial course of the artery was mapped out in the lower lateral part of the leg. This triangle should be considered during surgical approaches applied to the lateral hindfoot to avoid damage of the LCA. Clin. Anat. 22:834–839, 2009. © 2009 Wiley‐Liss, Inc.