The Significance of Medial Sural Artery Integrity in Popliteal Artery Trauma: A Case Report

Abstract

Two patients with popliteal artery trauma who underwent secondary amputations due to refractory calf sepsis despite a patent arterial repair are presented in this case report. The medial sural artery, the main arterial supply of the medial head of the gastrocnemius, was surgically severed in both patients owing to the use of a continuous medial incision from the supra level to infragenicular level. The compromised arterial supply of the medial head of the gastrocnemius muscle may have contributed to the devitalization of the muscle and the subsequent calf sepsis, and it is speculated that this was related to the unfavorable outcome.

The Medial Sural Artery as Recipient Vessel and the Impact on the Medial Gastrocnemius

“…9 In more recent times, a better understanding of the angiosomes of the lower limb has highlighted the collateral supply to distal medial gastrocnemius from perforators derived from the posterior tibial and femoral arteries. 10 Although only 4 patients were assessed, each with varied severity of lower limb injury, this small study does give credibility to these collateral vessels' ability to adequately perfuse the medial gastrocnemius.…”

“…[1][2][3][4][5][6][7] The medial sural artery (MSA) is perhaps less frequently used, given that it has previously been described as an end artery, interruption of the artery resulting in loss of the medial head of gastrocnemius. 8,9 However, more recent studies suggest that the distal medial gastrocnemius is also nourished by perforating branches of the posterior tibial and femoral arteries. 10 Tsetsonis et al have also described communications between the lateral and medial heads of gastrocnemius suggesting further collateral supply to the medial head.…”