Hand Reconstruction with Medial Sural Perforator Free Flap.

Ryu, Min Hee; Kim, Hyo Heon

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(6):715-722.
Published online November 1, 2006.

Hand Reconstruction with Medial Sural Perforator Free Flap.

Min Hee Ryu, Hyo Heon Kim

Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea. khhps@yumail.ac.kr

Abstract

PURPOSE
The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps. METHODS: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8 cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2 cm.
RESULTS
We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap.
CONCLUSION
In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.

Keywords: Hand reconstruction; Medial sural perforator free flap