The versatile free medial sural artery perforator flap: An institutional experience for reconstruction of the head and neck, upper and lower extremities

Abstract

BackgroundThe medial sural artery perforator (MSAP) flap is an increasingly versatile and reliable flap for soft tissue reconstruction. This study investigates complication rates and long‐term outcomes of the MSAP flap.MethodsA retrospective review was performed on consecutive patients undergoing MSAP flap reconstruction at Chang Gung Memorial Hospital from 2006 through 2017. Patient demographics were assessed. Flap failure and wound complications were the outcome measures.ResultsIn the cohort of 246 patients that underwent a total of 248 MSAP flap reconstructions were identified. The average age was 47.5 years (range 15–76). Of the 248 flaps, 170 were used for reconstruction of the head and neck, 48 for upper extremity reconstruction, and 30 for lower extremity reconstruction. The average MSAP flap size was 5.2 × 11.8 cm. 31 (12.5%) of the flaps developed arterial occlusion, venous insufficiency, or a hematoma postoperatively requiring re‐exploration. Nineteen were successfully salvaged, yielding an overall failure rate of 4.8%. Minor complications included the need for flap debridement in 18 cases (7.3%) and need for donor site debridement in eight cases (3.2%).ConclusionsThe MSAP flap can be used in a versatile fashion to reconstruct defects of the head and neck, upper extremity, and lower extremity with minimal complication rates.

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

“…There were number of anatomical studies have been done for MSAP flap [6,10,22,27]. 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].…”

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

“…This region is also a source of nearby nonvascularized grafts such as the saphenous nerve, plantaris tendon, and the lesser saphenous vein. 17,20,21 The Versatility As with any flap, enthusiastic use of the MSAP flap anywhere in the body will be eventually tempered by recognition of its true advantages (►Table 1) and disadvantages (►Table 2). Appropriate selection must consider all inherent qualities and also known risks.…”

“…The island posterior calf fasciocutaneous flap of Shaw et al 15 was used as a local pedicled flap for coverage of knee and tibial defects as an alternative to the gastrocnemius muscle, and occasionally required an intramuscular dissection of retained gastrocnemius musculocutaneous perforators for salvage, indeed then being transformed into a "true" perforator flap. 16 Numerous other recent reviews of the MSAP flap due it the justice it deserves, [17][18][19][20][21][22] but comparatively little effort has been spent in the utilization of calf fasciocutaneous flaps based on the lateral sural artery perforators, [23][24][25][26] primarily due to the common absence of those perforators altogether as found in most anatomical studies of this region. 1,2,27,28 Thus, to follow Taylor's admonition that a preferred free flap donor site has a reasonably predictable vascular supply, 6 this should explain why the emphasis presently only on the MSAP flap has caught everyone's attention, and is the rationale for this comprehensive overview also.…”

Vacuum sealing drainage combined with free anterolateral femoral skin flap grafting in 16 cases of pediatric soft tissue damage to the foot and ankle

“…In addition, careful postoperative supervision is required to prevent other complications. Also, given the immaturity of the pediatric vascular system with its thin diameter and poor pressure capacity, it is of great importance to anastomose as many large veins as possible while avoiding medically derived extravascular membrane injury so as to promote venous reflux and prevent the occurrence of venous crisis due to injury or edema (14). The main complications after surgery are infection, ISCHEMIA and necrosis of skin flap, hematoma under skin flap, joint stiffness and so on.…”