THE MEDIAL APPROACH TO THE SURAL VESSELS TO FACILITATE MICROANASTOMOSIS ABOUT THE KNEE

Complex wounds about the knee in rare instances may justify the select ion of a distant microvascular tissue transfer for coverage. A major p reoperative consideration then is the choice of an appropriate recipie nt site for revascularizing the flap that is outside the zone of injur y, and preferably avoids the need for vein grafts. In many cases, the heads of the gastrocnemius muscles have protected the sural vessels fr om injury, allowing these to be used as a vascular extension of the po pliteal system to simplify the required microanastomoses in an end-to- end fashion. Access to the sural vessels can be readily achieved throu gh a medial approach to the popliteal fossa that permits the patient t o remain supine or lateral on the operating table for simultaneous exp osure of multiple privileged donor sites.