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The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

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Vein grafts have been used for nerve repair in experimental and clinical studies. However, some concerns about their collapsability and the presence of valves which could block axonal growth have been put forth. We propose a modification to eliminate these potential problems by turning the vein inside out, obtaining an "invaginated" vein graft. We performed an experimental study on 61 adult Wistar rats, divided into 3 groups: control (non-operated) (n = 11); immediate repair, with 3 subgroups: invaginated vein graft (n = 10), vein graft (n = 10), and nerve graft (n = 10); and delayed repair, with 2 subgroups: invaginated vein graft (n = 10) and nerve graft (n = 10). Delayed repair was performed 3 to 4 weeks following division of the nerve. Electromyographical (EMG) assessment was performed in all operated animals at 2, 4, and 6 months after immediate reconstruction, and at 1 and 4 months after delayed repair. At the end of the study, all nerves were excised and a morphometric analysis was performed. We conclude that vein grafts are as useful as nerve grafts in immediate and delayed nerve repair, as there were no significant functional or histologic differences. We found no significant differences between invaginated vein grafts and non-invaginated vein grafts. However, electrophysiological results were slightly superior in the former. Regenerated axons were small, grouped in minifascicles with thin myelin sheaths. The venous adventitia did not interfere with axonal growth.

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