Medial sural artery perforator flap in reconstruction of soft tissue defect in upper and lower extremities: a clinical study

Figures & data

Figure 1. Position of the patient and location of the perforator

Figure 2. Medial incision and identification of the perforator

Figure 3. Dissection of the pedicle

Figure 4. Direct closure of the donor site

Figure 5. Skin graft of the donor site

Figure 6. Case 1. a: Palmer surface of right hand showing soft tissue defect. b: Dorsal surface of right hand showing soft tissue defect. c: Flap marking. d: Anastomosis site. e: Dissection of the perforator. f: Dissection of the pedicel. g: Flap in-setting Palmer surface. h: Flap in-setting dorsal surface. i: Donor side closure. j: Patient after 1 week. k: Patient after 1 month. l: Patient after 3 months. m: Patient after separation of index finger. n: Patient during separation of middle and ring fingers showing the perforator. o: Patient after 6 months. p: Patient after 6 months. q: Patient after 6 months. r: Patient after 8 months

Table 1. Summary of the data of the patients included in this study

Case	Age	Sex	Cause	Upper or lower extremitioes	Type of flap	Size of flap	Number of perforator	Reliability of perforator	Pedicle length	Donor site closure	Complication of flap	Complication of donor site	Flap success
1	9	MALE	POST TRAUMATIC	UPPER (hand)	free	6*9 cm	Double	Reliable	12 cm	Direct closure	infection	Infection wound dehiscence and hypertrophic scar	Passed
2	7	Female	Post burn contracture knee	Lower (popliteal fossa)	pedicle	6*9 cm	Single	Reliable	11 cm	Skin graft	– – – -	– – – – –	Passed
3	16	Male	Post traumatic	Lower(lower third leg)	free	5*8 cm	Single	Reliable	12 cm	Direct closure	Hematoma Venous congestion	– – – – –	Total flap loss
4	56	Male	Post tumor excision	Lower(upper third leg)	pedicle	6*12 cm	Single	Unreliable	– – -	Direct closure	– – – -	– – – – –	Abandoned
5	26	Male	Post traumatic	Lower(upper third leg)	pedicle	7*14 cm	Double	Reliable	12 cm	Skin graft	Hematoma Venous congestion	– – – – –	Partial flap loss
6	8	Male	Post traumatic	Upper (hand)	free	6*9 cm	Single	Unreliable	– – –	Direct closure	– – – -	– – – – -	Abandoned
7	9	Male	Post traumatic Contracture	Lower (lower third leg)	free	6*9 cm	Single	Reliable	11 cm	Direct closure	– – – -	Hypertrophic scar	Passed
8	16	Male	Post burn contracture knee	Lower (popliteal fossa)	pedicle	5*8 cm	Single	Reliable	10 cm	Direct closure	– – – -	– – – – –	Passed
9	51	Male	Post burn contracture hand	Upper(first web space)	Free	5*8 cm	Double	Reliable	12 cm	Direct closure	– – – -	– – – – –	Passed
10	8	Female	Post burn contracture knee	Lower(popliteal fossa)	pedicle	7*9 cm	Single	Reliable	11 cm	Skin graft	– – – -	– – – – –	Passed
11	16	Female	Post traumatic	Lower(upper third leg)	pedicle	6*10 cm	Single	Reliable	12 cm	Skin graft	– – – -	– – – – –	Passed
12	28	Male	Post traumatic	Lower(upper third leg0	Pedicle	7*9 cm	Single	Reliable	12 cm	Skin graft	– – – -	– – – – –	Passed
13	52	Male	Post burn contracture hand	Upper(hand)	Free	5*10 cm	Single	Reliable	12 cm	Direct closure	– – – -	– – – – –	Passed
14	18	Male	Post traumatic	Lower (lower third leg)	Free	6*10 cm	Double	Reliable	12 cm	Direct closure	Venous congestion	– – – – –	Total flap loss
15	18	Female	Post traumatic	Lower(lower third leg)	Free	6*10 cm	Single	Reliable	12 cm	Direct closure	– – – -	– – – – -	Passed
16	7	Female	Post burn contracture knee	Lower (popliteal fossa)	Pedicle	7*9 cm	Double	Reliable	11 cm	Skin graft	– – – -	– – – – –	Passed
17	12	Male	Post traumatic	Upper(hand)	Free	6*9 cm	Single	Reliable	12 cm	Skin graft	– – – -	– – – – –	Passed
18	31	Male	Post traumatic	Lower (upper third leg)	Pedicle	7*12 cm	Double	Reliable	12 cm	Skin graft	Venous congestion	– – – – –	Partial flap loss
19	8	Female	Post traumatic	Upper(hand)	Free	5*8 cm	Double	Reliable	11 cm	direct closure	– – – -	– – – – -	Passed
20	18	male	Post traumatic	Lower(upper third leg)	pedicle	6*9 cm	Double	Reliable	12 cm	Skin graft	– – – -	– – – – -	Passed

Figure 7. Case 2. a: Pre-operative photo showing the defect. b: Intraoperative photo showing the defect. c: Flap marking. d: Perforator dissection. e: Flap elevation. f: Flap insetting. g: Patient after 2 weeks. h: Patient after 2 months with good color match and thickness. i: Patient after 3 months. j: Donor side hypertrophic scar

Figure 8. Case 3. a: The defect in the left knee. b: Marking of the flap. c: Excision of the defect. d: Dissection of the perforator. e: Flap elevation. f: Flap insetting. g: Patient after 1 week. h: Patient after 1 month. i: Patient after 5 months. j: Patient after 11 months with good color match and thickness