Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery

The present study was undertaken to know the anatomical basis of medial sural artery (MSA) and its perforators in Nepalese.

The popliteal arteries of 16 preserved cadaveric lower limbs were injected with a mixture of red ink and glycerine. The number, location, diameter of perforators; length and intramuscular course of pedicle; the branching pattern of MSA were observed and measured.

The mean of 2.2 ± 1.2 perforators (range 0-4) was observed. The perforators were clustered between 8.6 and 25.7 cm from the popliteal crease and 0.3-7.5 cm from posterior midline of leg. The dominant perforators were observed in middle 1/3rd of the leg. The average pedicle length was 12.04 ± 3.27 cm. The intramuscular courses of pedicles were observed in deep and superficial strata in 65.7 and 34.3%, respectively. The MSA originated from popliteal artery in 62.5% and common sural artery in 37.5%. An accessory MSA was found in 12.5%. Type I and Type III branching patterns of MSA were observed in 31.2% each whereas Type II was found in 37.5%. The mean external diameter of perforators and MSA were 0.85 ± 0.27 mm and 2.2 ± 0.43 mm, respectively.

The metrical presentation of this study provides an easy access to know about the distribution of perforators and branching pattern of MSA which will help the surgeons to make a convenient plan to harvest the MSA perforator flap in Nepalese population.