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.  Challenging job  Free medial sural artery perforator flap is very suitable  21 clinic cases in our department

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

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

5.  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.  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.  Enormous function of the Doppler ultrasound.

8. skin Subcutaneous Tissue Deep Fascia Muscular Tissue

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

10. Superficial veinPerforator Secondary branch of the medial sural artery

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

12.  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

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

31. Thank you !