The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience

Chalmers, Richard; Rahman, K.M.A.; Young, So-Yu; Kennedy, Matthew J.; Endersby, S.; Adams, Josephine C.; Ahmed, Omar A.; Nugent, Michael; Ragbir, Maniram

doi:10.1016/j.bjps.2016.01.005

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…The principal advantages of this fascio-cutaneous free flap include a thin, pliable nature (10), with adequate pedicle length and a well-hidden donor site that can often be closed primarily with minimal functional deficit (9). Chalmers et al (11) commented the MSAP flap can provide a reliable alternative to the workhorse flaps in intra-oral reconstruction (11).…”

Section: Introductionmentioning

confidence: 99%

Medial sural artery perforator flap—indications, tips and pitfalls

Gulati¹,

Patel²,

Maini³

et al. 2021

Front Oral Maxillofac Med

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Following the description of the medial sural artery free flap by Cavadas et al., the MSAP free flap is proving to be a useful tool for the head and neck reconstructive surgeon. The authors review the available literature for MSAP free flaps in particular related to oral cavity reconstruction and share their technique and experience with the MSAP free flap reconstruction of oral cavity defects. Twenty nine prospective cases of oral cavity reconstruction with MSAP free flaps between October 2015 and May 2020 in a tertiary referral centre are discussed. The principle advantages of the MSAP flap include the favourable thickness (mean 9.29 mm), pliability, pedicle length (mean 12.4 cm) and favourable donor site (primary closure 93%). The mean number of perforators was 1.4. The mean vessel diameter for the artery was 1.43 mm and vein 3.42 mm respectively. The overall complication rate was 17% (5/29 cases). Key challenges include care during flap inset and avoidance of perforator twisting. Implantable dopplers are also recommended for postoperative flap monitoring. Useful technical tips and the recognised challenges in the literature associated with this flap are discussed. Overall, the MSAP flap can be a useful tool in the armamentarium of the head and neck reconstructive surgeon for oral cavity reconstruction.

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Section: Introductionmentioning

confidence: 99%

Medial sural artery perforator flap—indications, tips and pitfalls

Gulati¹,

Patel²,

Maini³

et al. 2021

Front Oral Maxillofac Med

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…They recommended the MSAP as the flap of choice for small intraoral soft tissue defects. 19 Hung et al reconstructed 27 subtotal glossectomy defects with the MSAP. One flap loss occurred and the complication rate for donor and recipient sites were 3.7 and 33.3%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Goh

Tan

et al. 2020

J Reconstr Microsurg

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Background For tongue reconstruction, the radial forearm flap (RFF) is commonly used. In the last decade, the medial sural artery perforator (MSAP) flap has been successfully used with reportedly superior donor-site outcomes. Our study is the first to compare the RFF and MSAP for reconstruction of partial glossectomy defects (<50% of tongue). Methods We conducted a retrospective review of 20 patients with partial glossectomy defects reconstructed at a tertiary referral center. Patient demographics, perioperative data, and postoperative complications were analyzed. Objective measures of speech, swallowing, and subjective patient satisfaction with their donor site were recorded. Results Ten RFF and MSAP were each used, with a mean partial glossectomy defect size of 40.5 and 43.5%, respectively. The MSAP was significantly thicker (7.8 vs. 4.3 mm, p < 0.05) with a longer harvest time (122.5 vs. 75.0 minutes, p < 0.05). There were no cases of free flap failure. Donor-site healing times were comparable, but the MSAP group experienced significantly less donor-site complications (n = 1 vs. n = 7, p < 0.05). Functional outcomes were comparable with 13 patients achieving normal speech and diet after 3 months (MSAP = 6 vs. RFF = 7, p = 1.00). All patients were satisfied with their donor-site outcome with the MSAP group having a marginally higher score. Conclusion Both flaps are good options for partial glossectomy reconstruction. Though more challenging to harvest, the MSAP gives comparable functional results and has become our first reconstructive option given its superior donor-site outcomes.

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“…The same surgical method was used in each case, similar to the surgical technique already reported in previous studies . A two‐team approach was used in each case.…”

Section: Methodsmentioning

confidence: 99%

“…The MSAP is becoming increasingly popular for head and neck reconstruction due to its versatility, thinness, pliability, long pedicle, and particularly favorable donor site. This flap has rarely been described in the otolaryngology literature, and the description and use of this flap is largely limited to plastic surgery and oral and maxillofacial literature . This may be in part due to the steep learning curve reported for this flap and the higher incidence of complications reported .…”

Section: Introductionmentioning

confidence: 99%

The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

Taufique¹,

Daar

Cohen

et al. 2018

The Laryngoscope

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Objectives The medial sural artery perforator (MSAP) free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. We aim to describe the MSAP flap and compare it to other commonly used free flaps in the head and neck. Study Design Retrospective case series. Methods A retrospective review of all MSAP cases performed at New York University Langone Health was performed from July 2016 to November 2017. We examined the patients’ age, diagnosis, history of prior radiation therapy, and comorbidities, as well as flap‐specific information and recipient site. Results Twenty‐one patients underwent a variety of different head and neck procedures with coverage using an MSAP flap. Recipient sites included tongue, cheek, soft and hard palate, cervical esophagus, and pharynx. Pedicle length ranged from 8 cm to 12 cm. The smallest surface area harvested was 24 cm2 (6 cm × 4 cm), and the largest was 120 cm2 (15 cm × 8 cm). The flaps ranged from 5 to 12 mm in thickness. Venous coupler size ranged from 2.0 to 3.5 mm. Primary closure of the donor site was achieved in 18 of 21 flaps. Twenty of 21 flaps were transferred successfully. Conclusion The MSAP flap is a highly versatile and reliable option for a thin, pliable soft tissue flap with a donor site that may be preferable over the radial forearm free flap and anterolateral thigh flap in complex head and neck reconstruction. Level of Evidence 4 Laryngoscope, 129:1330–1336, 2019

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The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience

Cited by 21 publications

References 17 publications

Medial sural artery perforator flap—indications, tips and pitfalls

Medial sural artery perforator flap—indications, tips and pitfalls

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

The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

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