The Clinical Application Of Medial Sural Vessels As Recipient Vessels In Repairing Traumatic Tissue Defects In The Lower Limbs

BackgroundThe use of medial sural vessels (MSVs) as recipient vessels to repair wounds in the lower limbs has been previously reported. However, there is controversy regarding the methods used to expose MSVs and the repairable area of the wound.MethodsEight fresh cadavers were used to determine the shape, outer diameter, and length of the MSVs arising from the popliteal vessels. Lower extremity wounds were repaired in 7 patients using free latissimus dorsi flaps with the MSVs as recipient vessels. The flap area ranged from 18 x 11 cm to 24 x 17 cm, and the postoperative follow-up time ranged from 7 to 60 months.ResultsThe outer diameter of the medial sural artery from the starting point of the popliteal artery was 2.48 +/- 0.24 mm. After descending 29.98 +/- 4.62 mm, the vessels entered the muscle; the outer diameter of the blood vessel upon entry was 2.24 +/- 0.17 mm. Notably, the outer diameter of the vessel was 1.88 +/- 0.09 mm only 2 cm after entering the muscle. Seven cases were treated clinically. In 6 cases, we used an approach between the medial head of the gastrocnemius muscle and the tibia to expose and anastomose the MSVs. In 1 case, the vascular diameter was mismatched. After surgery, the flap survived completely in 6 cases. The remaining case experienced epidermal necrosis in the distal part of the flap, which resolved spontaneously. There were no obvious complications.ConclusionsAn approach between the medial head of the gastrocnemius muscle and the tibia can easily expose and anastomose the MSVs in a lateral position. Latissimus dorsi flaps were useful in repairing limb wounds as far as the talocrural region with the MSVs as the recipient vessels.