Sural Arteries

arteriae surales

The sural arteries are two or three branches arising from the popliteal artery in the popliteal fossa that supply the gastrocnemius and soleus muscles and the overlying skin of the posterior calf. The medial and lateral sural arteries correspond to the two heads of gastrocnemius. They are accompanied by sural veins and provide the blood supply used in sural artery perforator flaps and reverse sural artery flaps.

Region: Lower Leg

Clinical Relevance

Clinical Notes

The sural arteries are the basis of the reverse sural artery flap, a workhorse flap for reconstruction of the lower third of the leg, ankle, and heel where direct closure is impossible after trauma or tumour resection. The flap's pedicle is based on the peroneal artery perforators and the sural artery-peroneal artery anastomosis. Gastrocnemius muscle flap for coverage of proximal tibial defects uses the sural artery as its dominant pedicle. In planning these procedures, Doppler mapping of sural artery perforators guides flap design.

Pathology

Common Injuries & Conditions

Reverse Sural Artery Flap for Lower Limb Reconstruction

The reverse sural artery flap, based on distal perforators from the peroneal artery communicating with the sural vessels, provides reliable soft tissue coverage of lower leg, ankle, and heel defects after open fracture or tumour resection, with Doppler-confirmed perforator location guiding the rotation arc.