Medial Sural Artery Flap Applied Anatomy And Clinical Studies

Chapter I Applied Anatomic Study of Medial Sural Artery Perforator FlapObjective To provide anatomic evidence for the application of medial sural artery perforator flap by approaching the number, area, type and external diameters of cutaneous branches based on medial sural artery perforator flap.Methods Choose 6 fresh lower limbs from Chinese adult cadavers and perform micro-anatomy to abserve the number of perforators based on medial sural artery perforator flap, and their external diameters, the pedicle lengths, the pedicle widths, and the longitudinal distances from the perforating point to popliteal crease and posterior midline of the leg. The data were analyzed with SPSS 11.0 statistical software.Results Totally 13 medial sural perforator flaps were found in 6 legs. 1～3 perforators were found in each leg (on average 2.2). 4 perforators (31%) were originated from medial sural arteries and 9 (69%) from lateral sural arteries. The points of emergence were found in an area of 6.5～16.0 cm from popliteal crease, and 1～4.5 cm from posterior midline. The average longitudinal distance from the first perforator to popliteal crease was 8.82±1.21 cm and 2.23±0.64 cm to posterior midline of the leg. The external diameter of vessel pedicle was 2.52±0.35mm, and external diameter of the perforator at deep fascia was 0.81±0.1mm.Conclusion The presence of medial sural artery perforator is consistent. It can offer adequate vascular pedicle and desirable caliber of vascular anastomosis with original artery. And its anatomic characteristic is very suitable for free grafting and pedicle skin flap reversing.Chapter II Clinical Study of Medial Sural Artery Perforator FlapObjective To probe the feasibility and therapeutic effect of repairing soft-tissue defect over distal limbs by using medial sural artery perforator flap.Methods 10 clinical cases of medium and small-sized soft-tissue defect over distal limbs were repaired by using medial sural artery perforator flap in our department from June 2008 to October 2009. 8 cases were repaired with free grafting, flap sizes ranging from 5cm×4cm～16cm×8cm. 2 cases were reconstructed with pedicle skin flap, flap sizes ranging from 5cm×7cm～6cm×10cm. The patients were evaluated at 3, 6, 9 and 12 months on the postoperative follow-up parameters including flap contour, blood supply, flap stability, locomotor activity, restoration of touch sensation, as well as the shape and motor function in donor site.Results 9 flaps survived smoothly in this group. Only 1 flap had vein articulo. But this flap also survived after the articulo was removed by suitable healing. Both the recipient site and donor site were primary intention healing. In 3~12 months (8 months on average) follow up, all flaps but one were thin, and they were characterized by soft texture, good color,and no ulceration happened. The feeling of all flaps had recovered to S2. As for the donor sites, seven of which had linear scars, and the left three had skin scars. And there was no effect on their motor function.Conclusion Medial sural artery perforator flap is a thin flap, having pleasing appearance, soft texture and minor surgical trauma. Free grafting is suitable for repairing skin and soft tissue defect of medium and small size in limbs. And reverse island flap is suitable for repairing soft tissue defect in knees and upper legs.