Summary
Introduction
The precise vascular anatomy of posterior lower leg skin is not well understood. Despite
being a potential donor site for sural artery perforator flaps, this region is rarely
used and underestimated. The aim of this study was to provide exact preoperative planning
for medial and lateral sural artery perforator flap harvest.
Methods
An anatomical study on 16 cadaveric lower legs was performed to determine the number
and location of all medial and lateral sural artery perforators in relation to five
fixed points (medial and lateral maleolus, calcaneus, medial and lateral condyle).
A Duplex study on 32 lower legs determined the number and location of dominant medial
and lateral sural artery perforators in relation to same anatomical points. Results
of the two studies were correlated.
Results
A total of 234 perforators were found in the anatomical (134) and Duplex studies (100).
A dominant lateral sural artery perforator was found in 9.4% of all lateral perforators
in 31% of dissected legs. A dominant medial sural artery perforator was found in 37%
of all medial perforators in 94% of legs. The difference in the number of dominant
medial and lateral perforators was significant (p < 0.001) in the anatomical study, while no significant difference was found in the
Duplex study (p = 0.920).
Conclusion
The anatomical study showed relative unreliability of sural region regarding number
of dominant perforators. Therefore, harvest of medial and particularly lateral sural
artery perforator flap is unsafe without preoperative perforator mapping. No significant
difference in location of dominant perforators was found between Duplex and anatomical
studies. Duplex proved reliable for planning of sural artery perforator flaps due
to high precision in detecting location of dominant perforators.
Keywords
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Article info
Publication history
Published online: May 30, 2012
Accepted:
April 30,
2012
Received:
August 27,
2011
Footnotes
☆Presented at EURAPS – 21st meeting of European Association of Plastic Surgeons, Manchester, UK, May 2010.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
