Medial sural artery perforator flap for head and neck reconstruction

Abstract

Aim:The aim is to study the assessment of feasibility of medial sural artery perforator (MSAP) free flap for head and neck reconstruction at our center.Materials and Methods:Oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa, and floor of mouth cancer attending our center were reconstructed using MSAP flap after oncologic resection. Handheld 8 MHz Doppler was used to identify the perforator preoperatively.Results:We reconstructed 10 patients using MSAP flap. The flap was designed according to defect and donor site was primarily closed in all cases. Excellent results were seen in nine patients reconstructed with MSAP flap without any postoperative complication. Flap failure occurred in one patient due to venous thrombosis. The thickness of flap ranged from 4 to 8 mm. The vascular pedicle length ranged from 9 to 13 cm.Conclusion:The MSAP flap is appropriate for medium-sized oral defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor-site morbidity which makes it comparable to other microvascular free flaps such as radial artery free flap (RAFF) and anterolateral thigh flap.

Medial sural artery perforator flap in reconstruction of soft tissue defect in upper and lower extremities: a clinical study

“…In our study donor site closure was performed primarily in 11 patients and skin grafts were needed in 9 patients. In comparison, with other researches Agrawal et al [14] said that all donor sites in 10 patients were closed primary and Nugent et al [12] said that the donor site in 6 patients was closed primary in 5 patients and a skin graft was needed in one patient. Regarding donor site complications we had two patients (10%) with hypertrophic scars.…”

“…The results of flap success in other studies were: Kao et al [10] had one failed case from 29 patients, Agrawal et al [14] worked on 10 patients with one failed case, Toyserkani et al [8] had worked on 10 patients with 6 uncomplicated cases, 2 total flap losses due to venous congestion, one case had a venous problem that was salvaged and one the flap was changed intraoperative, Chen et al [9] worked on 11 patients with one flap failed, Shun et al [15,16] worked on 31 patients with one flap failed due to pressure on the pedicle and Balan et al [13] worked on seven patients with one flap has a partial loss.…”

The Medial Sural Artery Perforator Free Flap: A Novel, yet Challenging and Versatile Flap for Head and Neck Reconstruction

“…The average length of a pedicle was 11.14 cm (8-16 cm). The distance between the major perforator and the popliteal crease on the line connecting the middle of the popliteal crease to the tip of the medial malleolus was 10.025 cm (8)(9)(10)(11)(12)(13)(14)(15), and the distance between the major perforator and the posterior midline was 1.475 cm (1-2 cm). In eight cases, the defect was mostly closed, and STSG was harvested in six others.…”

“…When sufficient bulk is required, it can be extracted as a chimeric flap with muscle, medial sural nerve, tendon, or lesser saphenous vein. Because one major branch of the medial sural arteries is usually preserved and multiple secondary vascular pedicles, such as contacts between the lateral and medial heads of the gastrocnemius muscle, are present, the danger of necrosis of the medial gastrocnemius muscle is minimal [10][11][12][13].…”

Do medial sural artery perforator flaps have better clinical outcomes compared to the rectus abdominis perforator (DIEAP) flap in reconstruction of glossectomy defects? A Prisma guided meta-analysis

“…[ 26 27 ] Perforator flaps offer several advantages over conventional microvascular free tissue transfer. [ 28 29 30 ] The DIEAP is based on the aforementioned vessel, originally harvested as a musculocutaneous flap for breast reconstruction. The conventional rectus abdominis free flap is commonly used for reconstructing glossectomy defects, however; it may result in abdominal weakness and hernia formation.…”