Anatomical study of the origin and course of the median superficial sural artery

Mağden, A.Orhan; Menderes, Adnan; Yılmaz, Mustafa; Barutçu, Ali

doi:10.1007/bf00209788

Cited by 13 publications

(8 citation statements)

References 8 publications

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“… 7 , 25 The median superficial sural artery arises proximally from the popliteal artery and is the largest of the 3 superficial sural arteries that together form a dense arterial network known as the sural angiosome. 26 , 27 The lesser saphenous vein transports retrograde venous flow from the flap and bypasses the valves of the deep venous system through anastomotic connections with the venae comitantes of the sural nerve. 8 …”

Section: Methodsmentioning

confidence: 99%

The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction

Sugg

Schaub

Concannon

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon. The reverse superficial sural artery flap (RSSAF) is a popular option for many of these difficult wounds. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. To overcome this, we have modified our operative technique, which has produced a more reliable flap.Methods:All patients reconstructed with an RSSAF between May 2002 and September 2013 were retrospectively reviewed. In response to a high rate of venous congestion in an early group of patients, we adopted a uniform change in operative technique for a late group of patients. A key modification was an increase in pedicle width to at least 4 cm. Outcomes of interest included postoperative complications and limb salvage rate.Results:Twenty-seven patients were reconstructed with an RSSAF (n = 12 for early group, n = 15 for late group). Salvage rate in the early group was 50% compared with 93% in the late group (P = 0.02). Postoperative complications (75% vs. 67%, P = 0.70) were similar between groups. Venous congestion that required leech therapy was 42% in the early group (n = 5) and 0% in the late group (P = 0.01).Conclusions:Venous congestion greatly impairs the survival of the RSSAF. A pedicle width of at least 4 cm is recommended to maintain venous drainage and preserve flap viability.

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Section: Methodsmentioning

confidence: 99%

The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction

Sugg

Schaub

Concannon

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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“…In conclusion, the MSSAP flap may be considered for posterior thigh soft tissue reconstructions, as it is commonly anatomically available to harvest and exposes a pedicle of sufficient length 12 14. This novel split MSSAP flap and MSAP flap proves to be a valuable option and alternative to free flaps for defects of posterior thigh area postextensive soft tissue resection.…”

Section: Discussionmentioning

confidence: 93%

“…As fasciocutaneous reconstructive techniques for lower limb sarcomas continue to develop,11 the MSSAP flap provides an alternative to free flap reconstructions in the distal third of posterior thigh. However, anatomical variants mean that this option is not always available as in 8% the median superficial sural artery is absent,12 and in some ways can be regarded as an opportunistic technique which can make dissection of the case significantly easier as there is little to no muscle dissection required. Furthermore, a careful dissection technique in addition to handheld Doppler ultrasound examination minimises the risk of necrosis of the medial head of the gastrocnemius muscle 13.…”

Section: Discussionmentioning

confidence: 99%

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Mazur

Osinga

2020

BMJ Case Rep

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Reconstruction of composite defects of the posterior thigh and knee is challenging. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. More recently, the medial sural artery perforator (MSAP) flap has been described for such defects, although may necessitate skin grafting of the donor site. To minimise the drawbacks with these options, we describe a combination of a median superficial sural artery perforator (MSSAP) flap and MSAP flap. This allows both tension free closure of the donor site without skin grafting, and facilitates coverage of a round defect by splitting the flap into two adjacent triangular flaps. This is the first report of posterior thigh defect reconstruction with a combination of MSSAP and MSAP flaps.

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“…1). This artery descends under the deep fascia and pierces it at the midpoint of the calf following the same course of the medial sural nerve, giving the blood supply to the superficial sural fasciomusculocutaneous flap 8 (Fig. 2).…”

Section: Surgical Anatomymentioning

confidence: 99%

Distally Based Superficial Sural Fasciomusculocutaneous Flap: A Reliable Solution for Distal Lower Extremity Reconstruction

Reyes¹,

Andrades²,

Fix³

et al. 2008

J reconstr Microsurg

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The objective of this study is to present a simple and rapid approach to elevate a consistent superficial sural fasciomusculocutaneous flap and show its clinical applications. All the patients with lower limb defects who underwent reconstruction using the distally based fasciomusculocutaneous sural flap were included in the study. The flap was elevated with a cuff of gastrocnemius muscle under the skin paddle, and the distal pedicle was dissected until 5 cm over the lateral malleolus. The donor site is primarily closed or skin-grafted. From March 2004 to August 2006, this distally based superficial sural fasciomusculocutaneous flap was applied to nine patients. All the defects resulted from traumatic injuries of the distal third of the leg, ankle, or foot, combined with bone or tendon exposure. Two flaps developed minor distal skin necrosis that recovered uneventfully with conservative therapy. The other flaps had an adequate postoperative evolution with good blood supply, contour, and function. The superficial sural fasciomusculocutaneous flap is a simple and consistent alternative for distal lower limb reconstruction, particularly when microsurgery is not available.

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Anatomical study of the origin and course of the median superficial sural artery

Cited by 13 publications

References 8 publications

The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction

The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction

Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction

Distally Based Superficial Sural Fasciomusculocutaneous Flap: A Reliable Solution for Distal Lower Extremity Reconstruction

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