Medial Sural Artery Perforator Flap for Intraoral Reconstruction Following Cancer Ablation

Abstract

In oral cavity reconstruction, the fasciocutaneous flaps of the distal extremities have always been preferred to any other kind of flap because of their thinness and pliability, which makes them adaptable to different areas in the oral cavity. The radial forearm flap is frequently considered the first choice for intraoral reconstruction, but the disadvantages of donor site morbidity include sacrificing a major artery to the hand and leaving a conspicuous donor site scar. The search for another primarily thinned skin flap as an alternative has led to the application of the medial sural artery perforator flap, which is harvested from the medial aspect of the upper calf. Between June 2003 and March 2007, 22 free medial sural artery perforator flaps were transferred for intraoral defects after cancer ablation, including tongue and floor of mouth (15 cases), buccal mucosa (5 cases), retromolar trigone (1 case), and anterior floor of mouth (1 case). We paid attention to the major perforator (vein > or =1 mm), which was confirmed by the endoscope, as the vascular relay for the skin flap. The size of the skin paddle varied from 7.5 x 4 cm to 17 x 8 cm. The main advantage of this flap is that it provides thin and pliable coverage to achieve better accuracy in the oral cavity. Other advantages of minimizing donor site morbidity include maintaining the function of the medial gastrocnemius muscle, avoiding the need to sacrifice major arteries of the leg, and possible primary closure of the donor defect.

A Strategic Approach for Tongue Reconstruction to Achieve Predictable and Improved Functional and Aesthetic Outcomes

“…Options of free tissue transfer for tongue reconstruction include the rectus abdominis myocutaneous flap, 6 the latissimus dorsi myocutaneous flap, 7 the radial forearm flap, 8 and, more recently, the ulnar forearm flap, 9 the anterolateral thigh flap, 10 -17 and the medial sural artery perforator flap. 18,19 Very little guidance in the literature on flap selection was found for tongue reconstruction. Most of the larger series focused on the evaluation of outcome using only one free flap for all tongue defects.…”

Functional reconstruction of subtotal glossectomy defects with radial forearm free flap: case report and review of literature

“…For the former, fl aps previously described include the infrahyoid myofascial fl ap, the medial sural artery perforator fl ap, the RFFF and the ulnar forearm fl ap. 3,9,[13][14][15][16][17] For the latter, fl aps described include the rectus abdominis myocutaneous fl ap, the latissimus dorsi myocutaneous fl ap, the PMMF, and the trapezius island fl ap. [4][5][6][7] The ALTF has emerged in recent decades as a popular option for head and neck reconstruction because of its reliability, long pedicle, and good donor-site morbidity.…”

“…Options of free tissue transfer for tongue reconstruction include the rectus abdominis myocutaneous fl ap, latissimus dorsi myocutaneous fl ap, radial forearm fl ap (RFFF), and more recently, the ulnar forearm and the anterolateral thigh fl ap (ALTF), and the medial sural artery perforator fl ap. [6][7][8][9][10][11][12][13][14][15][16][17] In our hospital, we have successfully used the PMMF for reconstruction of total glossectomy defects.…”

The Retromolar Trigone

“…Series of 22 free medial sural artery perforator flaps have been reported for reconstruction of intraoral defects after cancer ablation, including tongue and floor of mouth, buccal mucosa, retromolar trigone, and anterior floor of mouth. 27 This flap provides thin and pliable coverage (skin paddle can vary from 7.5 Â 4 to 17 Â 8 cm), minimal morbidity, maintaining the function of the medial gastrocnemius muscle and avoiding the need to sacrifice major arteries of the leg.…”