Abstract: Objective　To observe the course and branches of the medial and lateral sural arteries using digital subtraction angiography（ DSA） and to guide the application of perforator flaps from these arteries in repairing wounds in the middle and upper segments of the lower leg. Methods　A total of 10 patients with deep defects in the middle and upper segment of lower leg who received medial or lateral sural artery perforator flap transplantation were included in this study from September 2021 to September 2023. Preoperative DSA was performed to assess the course and branching patterns of the medial and lateral sural arteries. Additionally， handheld Doppler ultrasonography was utilized to precisely locate the perforators. The flaps were designed based on the location and size of the wound. The donor sites were either directly sutured or repaired by skin grafting. Postoperative follow-up was conducted to evaluate the recovery of limb function. Results　DSA revealed that the medial and lateral sural arteries descended from the popliteal artery， entering the medial and lateral heads of the gastrocnemius muscle， respectively. Based on the number of descending branches， the arteries were classified into four types： Type I （one main vessel trunk with no branches， 7 cases）， type IIA（ the main vessel formed 2 branches above the knee joint， 3 cases）， type IIB（ the main vessel formed 2 branches below the knee joint， 4 cases）， and type Ⅲ（ the main vessel formed ≥3 branches， 6 cases）. The diameters of the medial and lateral sural arteries at their origin were （1.59±0.6） mm and （1.47±0.58） mm， respectively. Handheld Doppler ultrasonography detected 1 to 4 perforators， with a mean of 2. All medial and lateral sural  artery perforator flaps survived successfully. Follow-up showed that the color， texture， and appearance of the flap was satisfactory and that the function of the affected limbs were restored. Conclusion　DSA can provide clear visualization of the course and branching patterns of the medial and lateral sural arteries. Combined with handheld Doppler ultrasonography detection for perforators， it can effectively guide the preoperative design and intraoperative dissection of perforator flaps supplied by these arteries. Medical and lateral sural perforator flaps can achieve favorable outcomes in wound repair of the middle and upper segments of the lower leg.

Key words: 　Digital subtraction angiography, 　Medial and lateral peroneal arteries, 　Perforator flap, 　Wound repair