Medial Sural Artery Perforator Flap for Repair of the Hand

Abstract

We report our experience of using the medial sural artery perforator flap in the reconstruction of soft tissue defects in the hand in seven cases with 1 to 2 year follow-up. The flap is harvested from the posteromedial aspect of the leg, just below the knee and superficial to the medial head of the gastrocnemius muscle. It is based on the perforator arteries and veins supplied by the medial sural artery. The flaps ranged in size from 14 x 10 cm to 8 x 6 cm. The donor area was closed directly or by a skin graft. All but one flap survived. The cosmetic results were satisfactory and without apparent bulkiness. Similarity of colour and thickness of the donor and recipient sites are advantages. We feel that this new flap is a satisfactory option for use in the hand, particularly for extended soft tissue defects on the dorsal hand.

Surgical Anatomy of the Medial Sural Artery Perforator Flap

“…neck and limb reconstruction. [6][7][8][9][10][11]14 Inclusion of the plantaris tendon, sural nerve, and gastrocnemius muscle increases its versatility as a chimeric flap. 15,16 Despite its advantages, concerns limiting its use include the variability of its vascular anatomy and the need for intramuscular dissection.…”

“…Taylor & Daniel 1 first suggested the medial sural vessels as the basis of a new flap donor site in 1975 and, two decades later, Montegut 2 presented the first clinical cases of the medial sural artery perforator flap. Subsequently, Cavadas 3 and other authors [4][5][6][7][8][9][10][11] reported small clinical series of its use and emphasized its many advantages and limited donor morbidity. In situations when a thin and pliable flap is needed, the radial forearm flap has traditionally been the choice flap.…”

Preservation of Hand Function Using Muscle Perforator Flaps

“…Xie et al [22] have similarly used only the medial sural artery perforator (MSAP) free flap for the hand. Pedicled paraumbilical perforator-based flaps from the abdomen, Figure 1 Schematic listing of the source vessel and muscle traversed (subscript) for most presently described muscle perforator flaps.…”

The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small‐to‐moderate size defects of the foot and ankle

“…In 2001, Hallock (2001 and Cavadas et al (2001) published a more extensive study about the mapping of the sural artery perforators, where also a series of six successful clinical cases of the medial sural artery perforator (MSAP) flaps, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction were included. Since then, other manifold studies assessed the anatomical basis of the MSAPs (Kao, Chang, Chen, Wie, & Cheng, 2010;Kim, Jeong, Seul, & Cho, 2006;Kosutic, et al, 2012;Okamoto, Sekiya, Mizutani, & Otsuka, 2007;Shimizu, Kato, Sato, & Taneda, 2009;Thione, Valdatta, Buoro, Tuinder, Mortarino, & Putz, 2004;Wong, Wong, Tan, Chew, & Tay, 2012) and its clinical versatility (Cavadas et al, 2001;Chen, Chen, & Lee, 2005; Chen, Chuang, Chou, Chen, & Wang, 2005;Chen, Yu, Chang, Deng, Wu, & Chen, 2008;Choi, Nam, Choi, Roh, Kim, & Hong, 2013;Hallock, 2014;He, Jin, Zhang, & Zhang, 2014;Ives & Mathur, 2015;Kao et al, 2010;Kim et al, 2006;Lin, Lin, Lin, Hsu, Ng, & Wei, 2011;Kao, Chang, Wie, & Cheng, 2009;Kim, Hwang, Kim, & Lee, 2009;Mao, Zhang, Cui, Peng, Wang, Yu, 2011;Nugent, Endersby, Kennedy, & Burns, 2015;Song, Wu, Zhang, Chen, Ding, Ye, Wu, & Yuan, 2015;Wong et al, 2012;Xie, & Chai, 2012;Xie, Gu, Gong, & Tang, 2007;Wang, Mei, Pan, Chen, Zhang, & Tang, 2013;Zheng, Liu, Dai, & Schilling, 2015).…”