Descripción anatómica de la irrigación del colgajo sural a pedículo distal en piezas cadavéricas

Abstract

Anatomical description of the blood supply of the distally based sural fl ap in eight lower limbs Background: The distally based sural fasciomyocutaneous fl ap is widely used in the coverage of deep soft tissue defects on the distal third of lower limbs. Aim: To perform a morphometric description of the perforating arteries that supplies the fl ap. Material and Methods: We used eight lower limbs from amputations performed above the knee. The limbs were injected through the popliteal artery with red colored latex. After the injection, the limbs were dissected to obtain a distally based sural fasciomyocutaneous fl ap. Once the fasciomyocutaneous island was obtained, the fl ap was elevated dissecting its pedicle. Once the whole fl ap was dissected, a morphometric registry of the lateral and medial perforating arteries was performed. The pivot point for the fl ap was set 5 cm above the upper border of the lateral malleolus. The distance between the upper border of the lateral malleolus and the emergence of each perforating artery was measured. Results: The sural nerve was identifi ed in all eight dissections. A perineural plexus was the source of the blood supply of the fl ap, in three of the eight dissections. In two dissections, three sural arteries were identifi ed (medial, median and lateral). The lateral sural artery was identifi ed in two dissections and the medial and lateral arteries in one. Three to six perforating arteries were identifi ed in the medial part of the pedicle and four to fi ve perforating arteries in the lateral part of the pedicle. Conclusions: The distribution of the sural artery along the fl ap's pedicle is very variable. The most common distribution in these dissections was in the form of a perineural plexus. Considering the distance from the lateral malleolus to the emergence of the perforating arteries, the pivot point of the fl ap, should be set approximately at 5.5 centimeters above the lateral malleolus.