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The medial sural artery perforator flap: translation from anatomic study to clinical application for lower extremity reconstruction

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Perforator flaps have become a popular option for soft tissue reconstruction due to their ability to provide pliable and durable coverage without the donor site morbidities of more traditional “workhorse” pedicled and free musculocutaneous flaps. Over the last several years, the medial sural artery perforator flap has been increasingly employed as a reconstructive option in both head and neck surgery and for coverage of extremity defects. The goal of this paper is to review the anatomy of the medial sural artery flap through cadaveric study and highlight the utility of this reconstructive option over other more traditional options including the anterolateral thigh flap and radial forearm free flap through the treatment of several extremity defects at our institution in both pedicled and free tissue transfer.

Methods

Four cadaveric lower extremities were dissected and the pedicle of the medial sural artery flap evaluated. Three clinical cases involving lower extremity reconstruction with the medial sural artery perforator flap at our institution were reviewed.

Results

Four cadaveric specimens with medial sural artery perforator (MSAP) flap dissected were evaluated for pedicle length (11–16.5 cm) and diameter (2–5 mm). Three clinical cases are described highlighting the utility of this reconstructive method.

Conclusions

Through our clinical implementation and cadaveric dissection, the MSAP flap was demonstrated to be a thin and pliable perforator option for reconstruction of the lower extremity in both pedicled and free fashion without significant sacrifice of pedicle length or donor skin paddle diameter. Advantages over more traditional “workhorse” flaps are highlighted.

Level of evidence: Level IV, therapeutic.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, University of Kentucky Medical Center, 740 S. Limestone Ste. K443, Lexington, KY, 40536, USA

    Christopher Howell & Lesley Wong

  2. University of Kentucky College of Medicine, Lexington, USA

    Maddie Tierney

  3. Department of Surgery, Queen’s University, Kingston, Canada

    Wesley Edmunds

  4. Southwest Shoulder Elbow and Hand Center, Tucson, AZ, USA

    Debra A. Bourne

  5. Massachusetts General Hospital, Boston, MA, USA

    Ian Valerio

Authors
  1. Christopher Howell
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  2. Maddie Tierney
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  3. Wesley Edmunds
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  4. Lesley Wong
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  5. Debra A. Bourne
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  6. Ian Valerio
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Corresponding author

Correspondence to Christopher Howell.

Ethics declarations

Ethics approval

Each of the cadaveric specimens used for this scientific study were obtained through an approved vendor of the academic institution. Each cadaver was donated with the expressed written consent of the deceased or legal guardians of the deceased for the purpose of biomedical research and anatomic investigation. This study adhered to the ethical standards as per the institutional review board.

Consent for Publication

Photographic consent as well as consent to participate in the research study was obtained from all research subjects.

Competing Interests

Christopher Howell, Maddie Tierney, Wesley Edmunds, Lesley Wong, Debra Bourne, and Ian Valerio have no conflicts of interest or competing interests to report.

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Howell, C., Tierney, M., Edmunds, W. et al. The medial sural artery perforator flap: translation from anatomic study to clinical application for lower extremity reconstruction. Eur J Plast Surg 46, 1265–1272 (2023). https://doi.org/10.1007/s00238-023-02131-8

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  • DOI: https://doi.org/10.1007/s00238-023-02131-8

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