The sural artery perforator flap for coverage of defects of the knee and tibia

Umemoto, Yasutaka; Adachi, Yasunori; Ebisawa, Katsumi

doi:10.1080/02844310410004964

Cited by 37 publications

(20 citation statements)

References 5 publications

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“…Taylor & Daniel 1 first suggested the medial sural vessels as the basis of a new flap donor site in 1975 and, two decades later, Montegut 2 presented the first clinical cases of the medial sural artery perforator flap. Subsequently, Cavadas 3 and other authors [4][5][6][7][8][9][10][11] reported small clinical series of its use and emphasized its many advantages and limited donor morbidity. In situations when a thin and pliable flap is needed, the radial forearm flap has traditionally been the choice flap.…”

Section: Introductionmentioning

confidence: 99%

Surgical Anatomy of the Medial Sural Artery Perforator Flap

Wong

Tan

et al. 2012

J reconstr Microsurg

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Background?The medial sural (medial gastrocnemius) perforator flap is a thin flap with a long pedicle. It has tremendous potential for applications in a variety of soft-tissue defects. We aimed to further clarify the vascular anatomy of the medial sural region and establish a safe approach for elevation of this flap. Methods?Ten fresh cadaveric lower limbs were injected and used in this study. We identified the locations and courses of the medial sural artery perforators and correlated them to anatomic landmarks. Results?The medial sural artery divides into two branches, a medial and lateral branch. Correspondingly, musculocutaneous perforators supplying the overlying skin were oriented in two parallel vertical rows, along the course of the lateral or medial branch of the medial sural artery. Two to six perforators were located 6 cm to 22.5 cm from the popliteal crease. Perforators from the lateral row, nearer the posterior midline, were generally larger. In most cases, a large perforator with a superficial, straight intramuscular course could be identified a mean of 10 cm distal to the popliteal crease and an average of 2 cm from the posterior midline. Based on the above findings, we successfully used this flap in five clinical cases. Conclusion?Perforators of the medial sural artery were arranged in a medial and a lateral row. Use of perforators from the lateral row, nearer the posterior midline, is preferable as these are usually larger in size. A consistent major perforator could always be identified in all specimens. With increased safety and confidence in flap harvesting, the medial sural artery perforator flap may find wider clinical applications. Clinical question: Therapeutic Level of Evidence: IV

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Section: Introductionmentioning

confidence: 99%

Surgical Anatomy of the Medial Sural Artery Perforator Flap

Wong

Tan

et al. 2012

J reconstr Microsurg

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“…A study has shown that ABCC1-overexpressing HL-60/ Adr cells are composed of more than 90 % SP cells (Patrawala et al 2005) that are not necessarily associated with increased CSC content. The SP phenotype has been used to identify and isolate normal stem cell populations from a variety of tissues including bone marrow (Goodell 2001), mammary glands (Welm et al 2003), skin (Montanaro et al 2003), liver (Wulf et al 2003), lung (Majka et al 2005), skeletal muscle (Meeson et al 2004), limbs (Umemoto et al 2005), heart (Martin and Dargie 2004) and brain (Kim and Morshead 2003). In addition, overexpression of the ABC transporter is usually related to stem cell markers such as CD133, nestin, CD117 (Adhikari et al 2010), Notch-1 and Nanog (Patrawala et al 2005;Bourguignon et al 2008) as well as Oct-4 .…”

Section: Introductionmentioning

confidence: 99%

Doxorubicin and 5-fluorouracil resistant hepatic cancer cells demonstrate stem-like properties

Nguyen

Tran³

et al. 2012

Cytotechnology

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The efficacy of hepatocellular carcinoma (HCC) treatment is very low because of the high percentage of recurrence and resistance to anticancer agents. Hepatic cancer stem cells (HCSCs) are considered the origin of such recurrence and resistance. Our aim was to evaluate the stemness of doxorubicin and 5-fluorouracil resistant hepatic cancer cells and establish the new method to isolate the HCSCs from primary cultured HCC tumors. HCC biopsies were used to establish primary cultures. Then, primary cells were selected for HCSCs by culture in medium supplemented with doxorubicin (0, 0.1, 0.25, 0.5 or 1 lg/mL), 5-fluorouracil (0, 0.1, 0.25, 0.5 or 1 lg/mL) or their combination. Selection was confirmed by detection of HCSC markers such as CD133, CD13, CD90, and the side population was identified by rhodamine 123 efflux. The cell population with the strongest expression of these markers was used to evaluate the cell cycle, gene expression profile, tumor sphere formation, marker protein expression, and in vivo tumorigenesis. Selective culture of primary cells in medium supplemented with 0.5 lg/mL doxorubicin and 1 lg/mL 5-fluorouracil selected cancer cells with the highest stemness properties. Selected cells strongly expressed CD13, CD133, CD90, and CD326, efflux rhodamine 123 and formed tumor spheres in suspension. Moreover, selected cells were induced to differentiate into cells with high expression of CD19 and AFP (alpha-fetoprotein), and importantly, could form tumors in NOD/SCID mice upon injection of 1 9 10 5 cells/mouse. Selective culture with doxorubicin and 5-fluorouracil will enrich HCSCs, is an easy method to obtain HCSCs that can be used to develop better therapeutic strategies for patients with HCC, and particularly HCSC-targeting therapy.

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“…A review of the English literature about pedicled medial sural perforator flaps for knee defects showed that Umemoto et al performed the flap in the upper third of the lower leg and low portion of the knee in four patients. Kim et al reported on their use of a medial sural perforator island flap for the reconstruction of postburn knee flexion contractures to cover the defect in the posterior knee in 12 patients.…”

Section: Discussionmentioning

confidence: 99%

Pedicled medial sural perforator flap for the reconstruction of knee defects

Chiang

Chen

et al. 2016

International Wound Journal

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Soft tissue defects exposing the patellar tendon or bone are common in patients who have experienced trauma or implant infection. The purpose of this article is to present our experience of six patients who underwent reconstruction of soft tissue defects of the knee using a pedicled medial sural perforator flap. Between November 2013 and November 2015, six patients who presented with a soft tissue defect overlying the knee were admitted to our hospital. After adequate debridement or wide excision of the tumour, these patients underwent pedicled medial sural perforator flap placement to resurface the complex soft tissue defects and to provide a gliding surface for the exposed patellar tendon. The patients' age, comorbidity, aetiology, defect size and location, flap size, perforator numbers and lengths, outcome and follow-up period were reviewed. The six medial sural perforator flaps survived completely, and the wounds healed satisfactorily over a mean follow-up of 21·5 months (range, 6-51 months). Donor sites were closed primarily or covered with a split-thickness skin graft. The medial sural perforator flap is a reliable flap for coverage of defects overlying the knee. The thin and pliable flap, long pedicle length and less donor site mobility benefit patients. Thus, the medial sural perforator flap may be a valuable alternative for defect reconstructions overlying the knee, which produces satisfactory results both functionally and cosmetically.

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The sural artery perforator flap for coverage of defects of the knee and tibia

Cited by 37 publications

References 5 publications

Surgical Anatomy of the Medial Sural Artery Perforator Flap

Surgical Anatomy of the Medial Sural Artery Perforator Flap

Doxorubicin and 5-fluorouracil resistant hepatic cancer cells demonstrate stem-like properties

Pedicled medial sural perforator flap for the reconstruction of knee defects

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