The Medial Sural Artery Perforator - anatomic basis for a surgical plan Origin of the perforators and of medial sural artery Sixty-six percent of perforators (25 out of 38) had origin from the lateral branch of the medial sural artery; 34% (13 out of 38) from the medial one. In all specimens the medial sural artery merged from the medial side of the popliteal artery: in 70% of cases, exactly at the popliteal crease, in the remaining 30% more proximally. Diameter of the medial sural artery The average diameter of the medial sural artery before its division in the medial and lateral branches was 2.2 mm (range, 1.7 mm to 3 mm); the medial sural vein at the same point had an average diameter of 2.6 mm (range, 2.3 mm to 3 mm). Only in 15% (3 out of 20) of specimens the bifurcation of the medial sural artery was out of the MGML at about 1.5 cm from the popliteal artery. In these three cases the origin of the medial sural artery was proximal to the popliteal crease. Pedicle length The average pedicle length from the bifurcation of the medial sural artery to the merging of perforators in the subcutaneous plane was 11.75 cm (range, 10 cm to 17 cm). DISCUSSION The vascular anatomy of the posterior calf region is based on the superficial sural artery and musculocutaneous perforators from medial and lateral sural arteries.2 The cutaneous and intramuscular distribution of these perforating branches is not well-known because less attention has been paid in the literature.2-7 Cavadas et al.2 first described precise topography of perforating vessels on medial and lateral gastrocnemius muscle and perform the MSAP in six clinical cases.2 Hallock described the anatomy of perforators of the posterior calf skin, and they underlined the potential for elevating a gastrocnemius perforator-based flap without the need for any muscle sacrifice.4 With this anatomical study we tried to add informations in order to simplify surgical planning and dissection (Fig.3.5, 3.6).8-11 38
5. lay-out phd DEFINITIEF_digitaal2
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