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The Anatomy and Clinic Application of Free Medial Sural Artery Perforator Flap

The Anatomy and Clinic Application of Free Medial Sural Artery Perforator Flap. Xin Wang M.D,  Jianwu Qi M.D Ningbo 6th Hospital, P.R.China 8 June 2013. HOW RECONSTRUCT APPROPRIATELY?. Challenging job Free medial sural artery perforator flap is very suitable

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The Anatomy and Clinic Application of Free Medial Sural Artery Perforator Flap

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  1. The Anatomy and Clinic Application of Free Medial Sural Artery Perforator Flap Xin Wang M.D,  Jianwu Qi M.D Ningbo 6th Hospital, P.R.China 8 June 2013

  2. HOW RECONSTRUCT APPROPRIATELY? • Challenging job • Free medial sural artery perforator flap is very suitable • 21 clinic cases in our department

  3. REVIEW • Cavadas :(Plast. Reconstr. Surg. 108:1609-1615, 2001) • Geoffrey G. Hallock: (Annals of Plastic Surgery 52:184-187 2004)

  4. REVIEW • Shao-liang chen: (Trauma 58:323-327, 2005) • Hyo Heon Kim:(Plastic and Reconstructive Surgery 117:1609-1618,2006)

  5. ANATOMY STUDY • 6 cadaveric specimens • at least one substantive perforator • Proximal perforator location: 6~12 cm from popliteal crease About 4 cm from posterior midline of the leg

  6. PATIENTS AND METHODS • April 2007 ~ Septemper 2010 • 21 patients , 16 men , 5 women • Age : 16 to 51 years • Recipient site :14 hands , and 7 feet. • Pay attention to the proximal major perforator

  7. Preoperative Design of The Flap • Enormous function of the Doppler ultrasound.

  8. skin Subcutaneous Tissue Deep Fascia Muscular Tissue

  9. OPERATIVE TECHNIQUE • Supine or prone position • Exsanguination and tourniquet control. • preserve a superficial vein of the flap. • Detach the flap beneath the deep fascia.

  10. OPERATIVE TECHNIQUE Secondary branch of the medial sural artery Superficial vein Perforator

  11. OPERATIVE TECHNIQUE • Intramuscular retrograde dissection • Adequate pedicle length and suitable caliber of artery. • the superficial vein • Donor site closed directly or covered with skin graft.

  12. RESULTS • 20 flaps surviving,1 flap partial necrosis • flap size :7.0×4.5cm to 12×8 cm. • 17 flaps with single perforator , 4 flaps with 2 perforators. • superficial vein of 16 flaps were anastomosed

  13. CASE 1

  14. CASE 1

  15. CASE 2

  16. CASE 2

  17. CASE 3

  18. CASE 3

  19. CASE 4

  20. CASE 5

  21. CASE 6

  22. CASE 6

  23. CASE 7

  24. CASE 7 superficial veins of the flap

  25. CASE 7

  26. CASE 7

  27. SPECIAL CASE

  28. SPECIAL CASE Direct cutaneous perforator

  29. FOLLOW-UP

  30. SUMARY • Little damage to donor site • Suitable for shallow defects • A long vessel pedicle • Can reconstruct sensation

  31. Thank you !

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