Superficial lateral sural artery free flap for intraoral reconstruction: anatomic study and clinical implications

Background: A posterolateral calf free flap is anatomically assessed and its usefulness for intraoral reconstruction is described.

Methods: Records of 42 cadaver dissections including anatomic parameters of the superficial lateral sural artery serving as pedicle were analyzed. Data of 20 patients with primary oral cancer who underwent reconstructions with posterolateral calf free flaps are presented.

Results: The superficial lateral sural artery was present in 36 of 42 of all cadavers (85.8%). In all, 25 specimens of 36 were suitable as flaps (69.4%). It originated from the lateral sural and the popliteal artery (31% vs 69%). It was accompanied by 1 vein (40.5%) or 2 veins (59.5%). The artery pierced the crural fascia on average 3 cm lateral to the midline and 0 to 12 cm below the fibular head. Eight patients had inadequate superficial lateral sural vessels and were reconstructed by peroneal perforator flaps. One flap was lost.

Conclusions: Cutaneous flaps from the posterolateral calf can be a useful alternative for reconstruction of moderate sized defects with minimal donor site morbidity.