The anatomy and clinical application of medial sural vessels

Abstract

To study the anatomical characteristics of the medial sural vessels and the clinical effects of treatment for leg skin and soft tissue defect with free flaps. 6 adult lower limbs were treated by latex perfusion and then observed the origin of the blood supply to gastrocnemius muscle, measure the number of the arteries and veins, the length and diameter of the medial sural vessels. From July 2009 to May 2013,15 clinical cases of serious skin and soft tissue defect were repaired by using free flap with medial sural vessels. The areas of wound surface were ranging from 13 cm × 7 cm-24 cm × 12 cm.10 of them were treated by anterolateral thigh flap, the other of them were treated by latissimus dorsi flap. The donor site were directly sutured or repaired by free skin graft. . The blood supply of gastrocnemius mucle was multifocal. The medial sural arteries and lateral sural arteries were both origin from popliteal artery. The medial sural vessels include 1 artery and 2 veins. With the length 4-7 cm (average,5.4 cm),the arterial diameter of the origin 2.6-2.9 mm (average,2.7 mm) and the entry point 1.9-2.3 mm (average,2.1 mm),the vein diameter of the origin 1.8-2.2 mm (average,2.0 mm)and the entry point 2.7-3.4 mm(average,2.9 mm).Totally 15 cases flaps were survived with primary healing. The mean follow-up period was 16.5 months(range,11-21 months),The flaps had satisfactory appearance, soft texture, good elasticity and achieved protective sensation at the last followed-up. The medial sural vessels are with constant anatomical position, deeply position, hardly damage, long pedicle. Thus, the medial sural vessels combine with free flap is an good choice for the reconstruction of leg skin and soft tissue defect