Clinical application of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue wounds of ipsilateral lower limbs_West China Medical Journal

Authors：

FAN Yongxi ^1,2,3 , Guy Romeo Kenmegne ^1,2 , YU You ^1,2 , DUAN Alin ^1,2,3 , YIN Yijie ^1,2 ,  FANG Yue ^1,2

1. Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Trauma Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Restorative and Reconstructive Department, NO.1 Orthopedics Hospital of Chengdu, Chengdu, Sichuan 610074, P. R. China;

Corresponding author：

FANG Yue, Email: fangyue1968@163.com

Keywords：

Medial sural artery perforator flap; lower extremity skin soft tissue defect; wound repair

DOI：

10.7507/1002-0179.202309022

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the therapeutic effect of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue defects in the ipsilateral lower extremities. Methods The clinical data of patients with small and medium area skin and soft tissue defects of lower limbs admitted to Restorative and Reconstructive Department, NO.1 Orthopedics Hospital of Chengdu between September 2021 and January 2023 was retrospectively analyzed. Basic information of patients was collected. The anatomical characteristics, application methods, and clinical results of the flap were recorded after operation, and the comprehensive efficacy evaluation table of the flap was used to evaluate the clinical efficacy at the last follow-up. Results A total of 13 patients were included. There were 12 males and 1 female. A total of 19 perforating branches of medial sural artery were found in the 13 cases, with an average of 1.46 perforating branches. The incision range of the flap was 5.5 cm×3.5 cm−13.5 cm×5.0 cm. Anterograde pedicle metastasis occurred in 3 cases and free transplantation occurred in 10 cases; mosaic flaps were used in 5 cases, lobed flaps in 1 case, and conventional perforator flaps in the remaining 7 cases. All the flaps survived successfully. All the 13 patients were followed up for 4-15 months, with an average of (10.38±3.64) months. The comprehensive score of flap efficacy was 77-92 points, with an average of (86.76±4.45) points. Among them, 5 cases were excellent, 8 cases were good, and the excellent and good rate was 100%. Conclusion The multifunctional features and flexible use of medial sural artery perforator flap increase the repair strategy of small and medium-sized wounds of the ipsilateral lower limbs, and can obtain better aesthetic repair results.

Citation： FAN Yongxi, Guy Romeo Kenmegne, YU You, DUAN Alin, YIN Yijie, FANG Yue. Clinical application of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue wounds of ipsilateral lower limbs. West China Medical Journal, 2023, 38(10): 1461-1467. doi: 10.7507/1002-0179.202309022 Copy

1.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
2.	Koshima I, Fukuda H, Utunomiya R, et al. The anterolateral thigh flap: variations in its vascular pedicle. Br J Plast Surg, 1989, 42(3): 260-262.
3.	Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6): 1609-1615.
4.	谭石, 李敬府, 白志勇, 等. 彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用. 中国临床医学影像杂志, 2012, 23(7): 488-491.
5.	Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
6.	唐举玉, 卿黎明, 吴攀峰, 等. 一种股前外侧穿支皮瓣血管切取的方法——逆行四面解剖法. 中华显微外科杂志, 2021, 44(2): 137-140.
7.	唐举玉, 章伟文, 张世民, 等. 特殊形式穿支皮瓣的名词术语与定义. 中国临床解剖学杂志, 2013, 31(2): 121-122.
8.	肖飞鹏, 柳志锦, 刘胜哲, 等. 综合评价量表在股前外侧皮瓣修复术后疗效评价中的应用. 中国美容整形外科杂志, 2021, 32(6): 348-351.
9.	Basnet LM, Ghosh SK, Shrestha S, et al. Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery. Surg Radiol Anat, 2018, 40(8): 935-941.
10.	Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
11.	Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1267-1275.
12.	Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3): 125-129.
13.	Potparić Z, Colen LB, Sućur D, et al. The gastrocnemius muscle as a free-flap donor site. Plast Reconstr Surg, 1995, 95(7): 1245-1252.
14.	Tsetsonis CH, Kaxira OS, Laoulakos DH, et al. The arterial communication between the gastrocnemius muscle heads: a fresh cadaveric study and clinical implications. Plast Reconstr Surg, 2000, 105(1): 94-98.
15.	Suba S, Giri SK, Pant P, Kanungo A. Versatility of medial sural artery islanded pedicled perforator flap for resurfacing areas around the knee. Ann Plast Surg, 2022, 88(6): 647-657.
16.	Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926, discussion 927.
17.	张功林, 章鸣, 张金福, 等. 腓肠内侧动脉穿支带蒂皮瓣修复髌前软组织缺损. 中华骨科杂志, 2007, 27(2): 144-145.
18.	Sui X, Khan UZ, Qing L, et al. The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities. Int Wound J, 2023, 20(7): 2679-2687.
19.	Kim ES, Hwang JH, Kim KS, et al. Plantar reconstruction using the medial sural artery perforator free flap. Ann Plast Surg, 2009, 62(6): 679-684.
20.	郑大伟, 黎章灿, 曹广超, 等. 腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤. 中国修复重建外科杂志, 2015, 29(12): 1519-1522.
21.	Lee CH, Chang NT, Hsiao JC, et al. Extended use of chimeric medial sural artery perforator flap for 3-dimensional defect reconstruction. Ann Plast Surg, 2019, 82(Suppl 1): S86-S94.
22.	Hallock GG. Medial sural artery perforator free flap: legitimate use as a solution for the ipsilateral distal lower extremity defect. J Reconstr Microsurg, 2014, 30(3): 187-192.
23.	Danielian A, Cheng MY, Han PS, et al. Medial sural artery perforator flap: a middle ground between anterolateral thigh and radial forearm flaps. Otolaryngol Head Neck Surg, 2023, 169(4): 852-857.
24.	Toyserkani NM, Sørensen JA. Medial sural artery perforator flap: a challenging free flap. Eur J Plast Surg, 2015, 38(5): 391-396.

1. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
2. Koshima I, Fukuda H, Utunomiya R, et al. The anterolateral thigh flap: variations in its vascular pedicle. Br J Plast Surg, 1989, 42(3): 260-262.
3. Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6): 1609-1615.
4. 谭石, 李敬府, 白志勇, 等. 彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用. 中国临床医学影像杂志, 2012, 23(7): 488-491.
5. Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
6. 唐举玉, 卿黎明, 吴攀峰, 等. 一种股前外侧穿支皮瓣血管切取的方法——逆行四面解剖法. 中华显微外科杂志, 2021, 44(2): 137-140.
7. 唐举玉, 章伟文, 张世民, 等. 特殊形式穿支皮瓣的名词术语与定义. 中国临床解剖学杂志, 2013, 31(2): 121-122.
8. 肖飞鹏, 柳志锦, 刘胜哲, 等. 综合评价量表在股前外侧皮瓣修复术后疗效评价中的应用. 中国美容整形外科杂志, 2021, 32(6): 348-351.
9. Basnet LM, Ghosh SK, Shrestha S, et al. Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery. Surg Radiol Anat, 2018, 40(8): 935-941.
10. Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
11. Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1267-1275.
12. Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3): 125-129.
13. Potparić Z, Colen LB, Sućur D, et al. The gastrocnemius muscle as a free-flap donor site. Plast Reconstr Surg, 1995, 95(7): 1245-1252.
14. Tsetsonis CH, Kaxira OS, Laoulakos DH, et al. The arterial communication between the gastrocnemius muscle heads: a fresh cadaveric study and clinical implications. Plast Reconstr Surg, 2000, 105(1): 94-98.
15. Suba S, Giri SK, Pant P, Kanungo A. Versatility of medial sural artery islanded pedicled perforator flap for resurfacing areas around the knee. Ann Plast Surg, 2022, 88(6): 647-657.
16. Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926, discussion 927.
17. 张功林, 章鸣, 张金福, 等. 腓肠内侧动脉穿支带蒂皮瓣修复髌前软组织缺损. 中华骨科杂志, 2007, 27(2): 144-145.
18. Sui X, Khan UZ, Qing L, et al. The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities. Int Wound J, 2023, 20(7): 2679-2687.
19. Kim ES, Hwang JH, Kim KS, et al. Plantar reconstruction using the medial sural artery perforator free flap. Ann Plast Surg, 2009, 62(6): 679-684.
20. 郑大伟, 黎章灿, 曹广超, 等. 腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤. 中国修复重建外科杂志, 2015, 29(12): 1519-1522.
21. Lee CH, Chang NT, Hsiao JC, et al. Extended use of chimeric medial sural artery perforator flap for 3-dimensional defect reconstruction. Ann Plast Surg, 2019, 82(Suppl 1): S86-S94.
22. Hallock GG. Medial sural artery perforator free flap: legitimate use as a solution for the ipsilateral distal lower extremity defect. J Reconstr Microsurg, 2014, 30(3): 187-192.
23. Danielian A, Cheng MY, Han PS, et al. Medial sural artery perforator flap: a middle ground between anterolateral thigh and radial forearm flaps. Otolaryngol Head Neck Surg, 2023, 169(4): 852-857.
24. Toyserkani NM, Sørensen JA. Medial sural artery perforator flap: a challenging free flap. Eur J Plast Surg, 2015, 38(5): 391-396.

West China Medical Journal

Clinical application of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue wounds of ipsilateral lower limbs

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content