Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

Abstract

IntroductionOncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use.Materials and methodsFrom December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted.ResultsA 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding.ConclusionThe MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake.

Outcome of Free Medial Sural Artery Perforator Flap (MSAP) for Head and Neck Reconstruction: A Systematic Review and Met Analysis

“…In this study, the dimension of flap was 9.4 cm x 5.5 cm, which shows close correlation with other similar studies [2,27]. Mean Pedicle length was found 10.5 cm, which is looked the same compared to others [2,5,6] In this study the range of perforators was 1 to 5, which is also similar compared to anatomical studies which was 1 to 8 [5,6,7,14,27]. Mean arterial diameter was 1.9 mm and vein was 2.9, it was also confirmed by other studies [5,6,7].…”

A Head-to-Head Comparison of the Medial Sural Artery Perforator versus Radial Forearm Flap for Tongue Reconstruction

“…This maintains adequate tongue mobility for swallowing and sufficient bulk to seal off spaces in the oral cavity during phonation for good speech. 4 It is generally recommended for flaps to be 20 to 30% wider and thicker than the actual glossectomy defect. 15 The RFF and ALT are traditionally described as workhorse flaps for this purpose in view of their inherent flap characteristics.…”

“…16,17 However, the RFF and ALT do come with significant drawbacks. [18][19][20][21] The main limitations of the RFF include (1) sacrifice of major upper limb vessels and risk of nerve injury causing numbness, 4,22,23 (2) requirement for skin grafting for donor-site closure with subsequent risk of partial graft loss, poor scarring, and dyspigmentation, 22,23 (3) lack of bulk of the neotongue, which is decreased further with shrinkage following radiotherapy, 24,25 and (4) cosmetically unfavorable scar. 2,23,26,27 The ALT alternative is commonly too thick for partial glossectomy defects which can cause food retention and speech unintelligibility, necessitating additional debulking.…”

“…Numerous other publications have similarly shown the MSAP to be well suited and reliable for partial and subtotal glossectomy reconstructions. 3,4,24,25,[31][32][33] Although it is often used as a fasciocutaneous flap, there is the possibility of functional glossectomy reconstruction with the addition of an innervated medial gastrocnemius chimeric muscle component, as described by Grinsell and Yue. 34 Only a few studies have directly compared the RFF with the MSAP for intraoral reconstruction.…”

“…The ideal flap needs to be of a suitable thickness and pliability to maintain tongue mobility for speech and sufficient bulk for deglutition. [2][3][4] In the past, regional flaps such as the pectoralis major myocutaneous flap were used with suboptimal outcomes including tethering of the tongue and unsightly neck bulge. 5 Free tissue transfer has since expanded the reconstructive surgeon's armamentarium to include distant thin and pliable soft tissue flaps for optimal functional tongue reconstruction.…”