Medial Sural Artery Perforator Flap

  • Klaus-Dietrich Wolff
  • Frank Hölzle


Based on the concept of myocutaneous flaps which was introduced in the late 1970s, the posterior aspect of the calf has been used as a donor site for local musculocutaneous flaps from the gastrocnemius muscle for defect coverage at the lower leg and around the knee joint [119, 142, 347, 348]. Before that, a successful local defect coverage with the lateral gastrocnemius muscle head, which was supplied by a direct branch of the popliteal artery, was reported by Pers and Medgyesi in 1973. In these first descriptions, the authors highlighted the excellent blood supply to both heads of the gastrocnemius muscle from either the medial or lateral sural artery, allowing for wide rotation of the muscle including skin to reach defects from above the patella down to the upper portion of the lower tibia and anterior lower leg. Because a substantial amount of tissue could safely be transposed into defects from a well-perfused donor site of the same leg, this technique immediately started to replace the formerly used crossleg flaps in lower-leg reconstructions. Consecutively, the muscle was transferred to the distal third of the lower leg as a free flap by Salibian et al. and Keller et al., thereby using the lesser saphenous vein as an interposition graft to elongate the sural artery [260, 452]. According to Matthes and Nahai, the muscle has a type I pattern of circulation [342].

Supplementary material

Video 14.1

Suralis medialis perf. (MP4 236951 kb)


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Klaus-Dietrich Wolff
    • 1
  • Frank Hölzle
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryKlinikum rechts der Isar, Technische Universität MunichMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital of RWTH Aachen UniversityAachenGermany

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