Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
J Reconstr Microsurg. 2012 Oct;28(8):555-60. doi: 10.1055/s-0032-1315778. Epub 2012 Jun 28.
The medial sural (medial gastrocnemius) perforator flap is a thin flap with a long pedicle. It has tremendous potential for applications in a variety of soft-tissue defects. We aimed to further clarify the vascular anatomy of the medial sural region and establish a safe approach for elevation of this flap.
Ten fresh cadaveric lower limbs were injected and used in this study. We identified the locations and courses of the medial sural artery perforators and correlated them to anatomic landmarks.
The medial sural artery divides into two branches, a medial and lateral branch. Correspondingly, musculocutaneous perforators supplying the overlying skin were oriented in two parallel vertical rows, along the course of the lateral or medial branch of the medial sural artery. Two to six perforators were located 6 cm to 22.5 cm from the popliteal crease. Perforators from the lateral row, nearer the posterior midline, were generally larger. In most cases, a large perforator with a superficial, straight intramuscular course could be identified a mean of 10 cm distal to the popliteal crease and an average of 2 cm from the posterior midline. Based on the above findings, we successfully used this flap in five clinical cases.
Perforators of the medial sural artery were arranged in a medial and a lateral row. Use of perforators from the lateral row, nearer the posterior midline, is preferable as these are usually larger in size. A consistent major perforator could always be identified in all specimens. With increased safety and confidence in flap harvesting, the medial sural artery perforator flap may find wider clinical applications.
TherapeuticLevel of Evidence: IV.
腓肠内侧（腓肠肌内侧）穿支皮瓣是一种带有长蒂的薄皮瓣，在多种软组织缺损中有广泛的应用潜力。本研究旨在进一步阐明腓肠内侧区域的血管解剖结构，并建立一种安全的皮瓣掀起方法。
本研究共使用 10 具新鲜的尸体下肢。我们确定了腓肠内侧动脉穿支的位置和走行，并将其与解剖标志相关联。
腓肠内侧动脉分为两支，即内侧支和外侧支。相应地，供应上方皮肤的肌皮穿支呈两条平行的垂直行排列，沿腓肠内侧动脉的内侧或外侧支走行。2 至 6 个穿支位于腘窝皱折线 6 厘米至 22.5 厘米处。靠近后正中线的外侧行穿支通常较大。在大多数情况下，可以在距腘窝皱折线 10 厘米、后正中线 2 厘米的位置识别出一条较大的、具有浅而直的肌内走行的大穿支。基于上述发现，我们成功地将该皮瓣应用于 5 例临床病例中。
腓肠内侧动脉的穿支呈内侧行和外侧行排列。使用更靠近后正中线的外侧行穿支更为可取，因为这些穿支通常较大。在所有标本中，始终可以识别出一条恒定的主要穿支。随着对皮瓣掀起的安全性和信心的提高，腓肠内侧动脉穿支皮瓣可能会有更广泛的临床应用。
治疗性。 证据等级：IV。
