Original ArticleThe Medial Sural Artery Perforators: Anatomic Basis for a Surgical PlanThione, Alessandro MD*; Valdatta, Luigi MD, FACS*†; Buoro, Mara MD*†; Tuinder, Stefania MD*†; Mortarino, Christian MD*†; Putz, Reinhard MD*†Author Information From the *Plastic Surgery Unit, University of Insubria, Ospedale di Circolo-Fondazione Macchi, Varese, Italy; and †Anatomic Institute, Ludwig-Maximilian University, Munchen, Germany. Received August 25, 2003 and accepted for publication, after revision, December 9, 2003. Reprints: Alessandro Thione, MD, Plastic Surgery Unit, University of Insubria, Ospedale di Circolo-Fondazione Macchi, Viale Borri 57, 21100 Varese, Italy. E-mail: [email protected] or [email protected] Annals of Plastic Surgery: September 2004 - Volume 53 - Issue 3 - p 250-255 doi: 10.1097/01.sap.0000116242.26334.b5 Buy Metrics AbstractIn Brief We performed an anatomic study on 20 fresh lower limbs. Resin was injected in the popliteal artery. Medial sural artery perforator flaps were sculptured according to anatomic markings. On average, length of flaps was 12.9 cm, width was 7.9 cm; all 38 perforators were musculocutaneous: 1 perforator was always found (on average, 1.9 per flap). All perforators gathered between 7 and 18 cm from the popliteal crease; 34.2% of perforators arose on the midline of the medial head of gastrocnemius muscle; before entering the fascia, the perforator artery diameter was on average 0.5 mm. Two configurations of the intramuscular course of perforators were found. Sixty-six percent of perforators originated from the lateral branch of the medial sural artery, 34% from the medial one. These results improve the anatomic knowledge of the medial posterior calf region and allow us to describe a convenient plan to make flap sculpturing easier. An injection study of 20 fresh lower limbs demonstrated an average of 1.9 musculocutaneous perforators entering the medial sural artery perforator flap at its base. Average diameter of the perforators was 0.49 mm, and two-thirds arose from the lateral branch of the medial sural artery rather than the medial branch. © 2004 Lippincott Williams & Wilkins, Inc.