Reconstruction of distal limb defects with the free medial sural artery perforator flap

Abstract

Background: The medial sural artery perforator flap is a reliable cutaneous flap that can be used for soft-tissue reconstruction in the extremities. The purposes of this article are to fully document the vascular basis of the medial sural artery flap and to report its use in reconstruction of distal extremities.

Methods: Ten fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using a spiral computed tomography scanner and specialized software (Materialise Interactive Medical Image Control System). The origin, course, and distribution of the medial sural artery perforator in the posterior leg region were observed. Between April of 2007 and December of 2010, the authors used the free medial sural artery perforator flap for distal limb reconstruction in 34 clinical cases. Flaps size varied from 5.5 × 4.5 cm to 14 × 9 cm.

Results: The average diameter of medial sural artery perforators was 0.9 ± 0.2 mm, with each perforator supplying an average territory of 55 ± 20 cm. Extensive anastomoses were found between the medial sural artery perforators and multiple adjacent source arteries. Twenty-nine flaps (85.3 percent) fully survived and five (14.7 percent) underwent partial necrosis. Follow-up observations were conducted for 6 to 21 months, and the cosmetic results were satisfactory and without apparent bulkiness.

Conclusions: The free medial sural artery perforator flap transfer is appropriate for extremity defect reconstruction. The donor site not only supplies a thin skin flap but also provides the option to harvest a cross-boundary perforator flaps that could be useful for repairing widespread traumatic soft-tissue defects.

Clinical question/level of evidence: Therapeutic, IV.