Reconstruction of Distal Limb Defects with the Free Medial Sural Artery Perforator Flap

Introduction: 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.

Methodology and Material: 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 (MIMICS). The origin, course, and distribution of the medial sural artery perforator in the posterior leg region were observed. Between April of 2007 and October of 2013, the authors used the free medial sural artery perforator flap for distal limb reconstruction in 56 clinical cases. Flap size varied from 5.5×4.5 cm to 14×9cm.

Results: The average diameter of medial sural artery perforator was 0.9 ± 0.2mm, with each perforator supplying an average territory of 55 ± 20cm2. Extensive anastomosis were found between the medial sural artery perforators and multiple adjacent source arteries. Forty-five flaps (91.1%) fully survived and five (8.9%) underwent partial necrosis. Follow-up observations were conducted for 6 to 25 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.