The medial approach to the sural vessels to facilitate microanastomosis about the knee.

Complex wounds about the knee in rare instances may justify the selection of a distant microvascular tissue transfer for coverage. A major preoperative consideration then is the choice of an appropriate recipient site for revascularizing the flap that is outside the zone of injury, and preferably avoids the need for vein grafts. In many cases, the heads of the gastrocnemius muscles have protected the sural vessels from injury, allowing these to be used as a vascular extension of the popliteal system to simplify the required microanastomoses in an end-to-end fashion. Access to the sural vessels can be readily achieved through a medial approach to the popliteal fossa that permits the patient to remain supine or lateral on the operating table for simultaneous exposure of multiple privileged donor sites.