Free medial sural artery perforator flap for resurfacing distal limb defects

Background: The need for thin flap coverage has increased, especially for contouring or covering shallow defects of distal limbs. The free medial sural artery perforator flap harvested from the medial aspect of the upper calf can be useful for this purpose. Methods: Between January 2002 and February 2003, we used the free medial sural artery perforator nap for distal limb reconstruction in 11 clinical cases, including four hands and seven feet. This perforator flap is based on the proximal major perforator of the medial sural artery, which can be identified along the axis of the medial sural artery and usually emerges in an area between 6 and 10 cm from the popliteal crease and approximately 5 cm from the posterior midline of the leg. Results: Most of the flaps were safely raised with a single perforator. One flap developed venous congestion during the postoperative course and finally underwent total necrosis. Conclusions: The main advantage of the medial sural artery perforator flap is that it only requires cutaneous tissue to achieve better accuracy in reconstructive site, and it preserves the medial gastrocnemius muscle and motor nerve to minimize donor-site morbidity. However, the tedious process of intramuscular retrograde dissection of the perforator and the unsightly scar of the donor region are the major concerns.