An Applied Study In Medial Sural Artery Perforator Flap With High Resolution Ultrasound

Objectives To study the distribution, localization and hemodynamic parameters of the medial sural artery perforator flap(MSAP) with color doppler flow imaging(CDFI).Methods We divided 30 normal volunteers into 3 age groups : 20~39 years old、40~59years old、60~75 years old.Each group contained 10 men and 10 women.The Proportion of age was same.we detected bilateral MSAP wear vascular by CDFI technology.By inspectors take supine, the knee and hip flexion and mild outreach extorsion.Firstly sign popliteal ridge and midline.popliteal fossa popliteal ridge for leg buckling is skin creases to form a straight line.midline of popliteal lines point to heel midpoint attachment, popliteal lines the inside line after the midline and popliteal grain to the end to the medial malleolus attachment covering area of the medial sural artery branch.Combine 2D with color doppler image to recognize PA,NSA.The front and back branch of NSA,the number of its wear branch and initial diameter was recorded.We measured the blood flow parameters including Vmax,Vtamx and Vmin.The body surface where the wear branch to deep fascia was marked.The distance between wearing point and midline and popliteal lines was measured.The type of vessels(intramuscular perforators, muscular clearance skin perforators, direct skin perforators) was recorded and blood flow parameter was measured.After detecting,the distance between the most prominent point of medial condyle and the most prominent point of the medial malleolus namely the condyle from ankle(D),was measured.point We divide D to nine section to determine the point where the wear branch through the deep fascia.Tibial medial condyle is 0, medial malleolus is9, we showed each wearing a starting point and the deep fascia through the point and the total wear a starting point and deep fascia wear a point location of the body surface as a histogram.The NSA,front and back branch of NSAand wear branch of NSA,blood flow parameters was analysed statistically.(P <0.05)for the difference is statistically significant.Results Sura inside the skin, subcutaneous tissue, muscle line levels was showed clearly.CNSA, front and back branch of the NSA, perforators(diameter>0.6mm) of pipe diameter, pipe wall, line position, line direction and whether wearing into the subcutaneous tissue can be displayed.The number of bilateral femoral anterolateral flap perforators, line source, location, and location of wearing a deep fascia is not symmetrical.60 side of the lower limbs were observed in the medial sural artery intramuscular perforators, 112, 1 ~ 4on each side, an average of 2.8,including The medial sural front branch 38(32%),back branch 74(68%).The point of wearing branch was 6.5~16.0cm away popliteal fold and1~4.5 cm away from the midline.The distance between first branch and popliteal fold is8.82±1.21 cm and between first branch and midline is 2.23±0.64 cm.the distance between the most prominent tibial medial condyle points and the medial malleolus most prominent point is divided into nine segments.The widest perforator among first branch accounted for 82.3%.76.4% of point of the 112 perforators was found to originate from the,3th,4th,5th,sections between the condyle and the ankle. 86.9% of the point of deep fascia was found to originate from the 4th,5th,6th.96.1% of the perforators was found penetrating the deep fascia from the 4th, 5th and 6th sections of the ligature between the condyle and the ankle.87.5% is appear at 4th, 5thsections.Spectrum showed that in the low diastolic blood flow velocity which was a low-speed high-resistance single-phase spectrum.nearly disappeared. the mean blood flow velocity and the age groups was not statistically significant difference(P>0.05), the male was slightly higher than that of female(P>0.05)Conclusions 1 CDFI technique can clearly show the figuration of MSAP and detect the parameters of this artery,through which the disorders and variance of MSAP will be identified. 2 CDFI can vividly display the derivation, distribution, localization of the perforators of MFF.3 CDFI can be applied to access the vascular status to underlie the surgical design of MFF and to monitor the vascular status at the follow-up.