Summary
Background and objectives
The blood supply of the lower one-third of the sartorius muscle is mainly provided
by the descending genicular artery (saphenous artery). The terminal branches of the
saphenous artery, together with the perforators of the posterior tibial artery and
medial inferior genicular artery, form a stable and rich anastomotic network in the
genus inferior medialis. Based on this anatomy, we designed a retrograde sartorius
myocutaneous flap to repair wounds in the proximal and middle thirds of the lower
leg.
Methods
A sartorius myocutaneous flap with the posterior tibial (or medial inferior genicular)
artery perforators as the pedicle was designed. The flap was based on a retrograde
flow route: medial inferior genicular and posterior tibial artery perforators, the
vascular network at the inferomedial knee, the saphenous artery, saphenous artery
perforators, to the sartorius muscle. With this design, the flap can be transferred
to the middle and proximal tibia. Between January 2007 and June 2010, 12 patients
with middle/proximal lower-leg wounds were successfully treated with this method.
Results
Ten of 12 myocutaneous flaps survived with primary healing of wounds. Two cases developed
a small degree of distal superficial skin necrosis but with normal muscular blood
supply and healed after conservative treatment.
Conclusion
Retrograde sartorius myocutaneous pedicle flaps from the perforating branches of the
medial inferior genicular artery or posterior tibial artery have advantages in terms
of reliable blood supply, ease of operation and minimal amount of damage, and can
be used to repair proximal and middle lower-leg wounds. They are especially applicable
when lower-leg flaps are unavailable due to poor soft-tissue conditions following
trauma or multiple operations. However, the safety flap size needs to be determined
in future studies.
Keywords
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Article info
Publication history
Published online: April 23, 2012
Accepted:
March 26,
2012
Received:
September 29,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
