Medial Sural Artery

Perforator Flap 26

The medial sural perforator flap was described Within the muscle, the medial sural artery may be
in a very similar fashion in cadaver dissections either a dominant vascular pedicle or may divide
by Taylor and Daniel [1] as a potential free flap into two branches that run longitudinally between
donor site as early as 1975. Baek [2] was the the muscle fiber bundles and give off musculocu-
first to report its clinical applications along with taneous perforators to the overlying skin [4, 5].
anatomical observations regarding medial and The medial sural artery runs along an imagi-
lateral femoral free flaps. The true medial sural nary line connecting the midpoint of the popliteal
perforator free flap was first introduced by crease and the midpoint of the medial malleolus.
Cavadas et al. [3]. At least one large musculocutaneous perfora-
tor exits through the medial head of the gastroc-
nemius muscle to allow the creation of a true
26.1 Vascular Anatomy perforator flap using the overlying calf skin terri-
tory. The majority of these perforators are clus-
The medial sural artery arises from the popliteal tered in the distal half of the muscle and emanate
artery and, after running 2–5 cm, enters the deep near the raphe separating the two heads of the
surface of the medial gastrocnemius muscle. gastrocnemius [6, 7].

C. Hou et al., Surgical Atlas of Perforator Flaps: A Microsurgical Dissection Technique, 199
DOI 10.1007/978-94-017-9834-1_26, © Springer Science+Business Media Dordrecht 2015
200 26 Medial Sural Artery Perforator Flap

26.2 Illustrative Case Flap Elevation

The lateral and/or distal border of the flap is
A 37-year-old woman suffered a crushing injury first raised to confirm the location and size of the
to the medial side of her right lower leg, with perforators (Fig. 26.5). Next, an intramuscular
overlying soft tissue loss measured 6.5 × 5.0 cm dissection of the identified perforator through the
(Fig. 26.2). medial gastrocnemius muscle proceeds back to
Flap Design the medial sural vessels to obtain the desired ped-
The design of the desired flap is centered icle length. The remaining boundaries of the flap
around the most distal perforator found to ensure are incised through the deep fascia (Fig. 26.6).
the longest possible pedicle (Fig. 26.3). The main The flap was rotated 180° to cover the defect.
perforators of the medial sural artery are located The donor site was closed directly (Fig. 26.7).
on a line drawn from the midpoint of the popli- Follow-Up
teal crease to the midpoint of the medial malleo- The flap survived well and allowed unre-
lus. Using an audible Doppler probe to locate a stricted ambulation, and a linear scar of the donor
distal perforator over the medial calf, a template area was obtained 3 months postoperatively
of the defect was then centered about this point to (Fig. 26.8).
create a 6.5 × 4.2 cm flap (Fig. 26.4).

Fig. 26.1 Vascular

anatomy of the medial
sural artery

Semitendinosus
Popliteal artery
Medial inferior genicular artery

Medial head of gastrocnemius muscle

Medial sural artery

Fig. 26.2 Preoperative

view
26.2 Illustrative Case 201

Fig. 26.3 Flap design

Fig. 26.4 Schematic

drawing of flap design

Fig. 26.5 Perforator

vessel visualization
202 26 Medial Sural Artery Perforator Flap

Fig. 26.6 Schematic

drawing of the flap
elevation

Fig. 26.7 Flap transfer

and insetting

Fig. 26.8 Follow-up

References 203

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10. Mao C, Zhang L, Cui QJ, Peng X, Wang Y, Yu GY.
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