Coverage of defect over toes after failure of microsurgical replantation with medial sural artery perforator flap: A case report

Lee, F.A.C.S. Gordon; Jeong, Eun Jeong

doi:10.1002/micr.22415

Cited by 3 publications

(1 citation statement)

References 15 publications

(35 reference statements)

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“… 74 The MSAP free flap, depending on the proper patient body habitus and when only a small to moderate sized flap is required, can be used successfully for all zones. 49 101 109 Much like use of the archival cross-leg flap to cover the foot, a contralateral MSAP free flap could be used in a single stage as an immediate cross-leg flap without the need for a microanastomosis—but beware of that technical exercise, as it is far better today to use the ipsilateral version to restrict morbidity to only a single lower extremity! 110 Plantar reconstruction remains our nemesis, as any flap choice must withstand constant weight-bearing pressures and shear forces, which some say must include protective sensation.…”

Section: The Versatilitymentioning

confidence: 99%

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

Hallock

2022

Arch Plast Surg

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Rather than just another “review,” this is intended to be an “overview” of the entire subject of the medial sural artery perforator (MSAP) flap as has been presented in the reconstructive literature from its inception in 2001 until the present, with any exceptions not purposefully overlooked. Unfortunately, the pertinent anatomy of the MSAP flap is always anomalous like most other perforator flaps, and perhaps even more variable. No schematic exists to facilitate the identification of a dominant musculocutaneous perforator about which to design the flap, so some adjunctive technology may be highly valuable for this task. However, if a relatively thin free flap is desirable for a small or moderate sized defect that requires a long pedicle with larger caliber vessels, the MSAP flap deserves consideration. Indeed, for many, this has replaced the radial forearm flap such as for partial tongue reconstruction. Most consider the donor site deformity, even if only a conspicuous scar on the calf, to be a contraindication. Yet certainly if used as a local flap for the knee, popliteal fossa, or proximal leg, or as a free flap for the ipsilateral lower extremity where a significant recipient site deformity already exists, can anyone really object that this is not a legitimate indication? As with any perforator flap, advantages and disadvantages exist, which must be carefully perused before a decision to use the MSAP flap is made. Perhaps not a “workhorse” flap for general use throughout the body, the MSAP flap in general may often be a valuable alternative.

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Section: The Versatilitymentioning

confidence: 99%

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

Hallock

2022

Arch Plast Surg

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Third Toe Pulp Reconstruction Using the Contralateral Second Toe Hemi-pulp Free Flap

Kusuhara

Sueyoshi

Nagumo

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: A hemi-pulp flap is widely known as a flap useful for aesthetic and functional reconstruction of the fingers, and rarely used for toe reconstruction. We performed third toe pulp reconstruction using a free hemi-pulp flap harvested from the contralateral second toe to repair the tissue defect following toe replantation. An 18-year-old woman was injured with complete left third toe amputation and open fracture of the proximal phalanx of the left second toe in a traffic accident. On the same day, third toe replantation was urgently performed. After surgery, the third toe was partially taken, and had a toe pulp tissue defect due to necrosis. It was reconstructed with a free hemi-pulp flap prepared from the contralateral second toe. The flap was completely taken. Three years after surgery, the reconstructed left third toe was aesthetically favorable. Perception of the flap region was restored up to S2 without pain and there was no complication such as numbness, callus, and ulceration. In the flap donor site (right second toe), the skin graft was unnoticeable without pigmentation. Toe pulp reconstruction requires a sensory flap as low-invasive as possible with excellent sensory restoration, texture, feel, and shear property. This method is considered as one of the low-invasive, aesthetic, and functional reconstruction methods.

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Aesthetic Multiple-Toe Reconstruction With Combined Iliac Bone Graft and Wraparound Free Anterolateral Thigh Flap—A Case Report and Literature Review

Kwon

Lao

Yen

et al. 2017

Annals of Plastic Surgery

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Compared with upper extremity injuries, toe amputations and their replantations are rare because of the difficulty of their relatively thinner soft tissue envelope. Consequently, fewer reconstructive options are available for toes and they are rarely reported in the literature. In this study, we reported a case of right third to fifth toe amputations and their subsequent reconstruction with iliac bone grafts and a free anterolateral thigh flap. After serial debulking and division procedures, 3 toes were divided successfully. Ten months after the initial operation, the patient regained pain-free functional ambulation despite some bone resorption noted on follow-up radiographs. The patient showed high satisfaction on her new toes in terms of aesthetical and functional outcomes. She was able to stand for over 30 minutes without pain. At the 2-year follow-up, the Foot Function Index was 18.3%. Although toe reconstruction is frequently considered unnecessary because of its relative high demand of surgical techniques and little gain on gait; nonetheless, in selected cases, toe reconstruction may still be beneficial if the metatarsophalangeal joints were intact and there is a strong individual desire for aesthetical restoration.

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Coverage of defect over toes after failure of microsurgical replantation with medial sural artery perforator flap: A case report

Cited by 3 publications

References 15 publications

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

Third Toe Pulp Reconstruction Using the Contralateral Second Toe Hemi-pulp Free Flap

Aesthetic Multiple-Toe Reconstruction With Combined Iliac Bone Graft and Wraparound Free Anterolateral Thigh Flap—A Case Report and Literature Review

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