title: The medial sural artery perforator free flap.
abstract: The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.
authors.affiliation: Reconstructive and Hand Surgery Department, Centro de Rehabilitación de Levante, University of Valencia, Spain. cavadas@ctv.es
authors.forename: P C
authors.initials: PC
authors.lastname: Cavadas
authors.forename: J R
authors.initials: JR
authors.lastname: Sanz-Giménez-Rico
authors.forename: A
authors.initials: A
authors.lastname: Gutierrez-de la Cámara
authors.forename: A
authors.initials: A
authors.lastname: Navarro-Monzonís
authors.forename: S
authors.initials: S
authors.lastname: Soler-Nomdedeu
authors.forename: F
authors.initials: F
authors.lastname: Martínez-Soriano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D007869:Leg Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012867:Skin / Q000098:blood supply*; D013524:Surgical Flaps / Q000098:blood supply*; D018608:Ultrasonography, Doppler