The Versatility of the Pedicled Medial Sural Artery Perforator Flap: From Simple to Its Chimeric Pattern and Clinical Experience with 37 Cases

Scaglioni, Mario F.; Rodi, Timo; Fritsche, Elmar

doi:10.1097/prs.0000000000007795

Cited by 7 publications

(12 citation statements)

References 43 publications

(71 reference statements)

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“…Most remarkably, it allowed the patient's prompt commencement of functional rehabilitation. While the pedicled MSAPF's reconstructive potential has been granted in other etiologies, 7,8 the present report outlines its significant potential in the case of electrical injuries, which has scarcely been acknowledged before. 9…”

Section: Discussionmentioning

confidence: 77%

Bilateral Knee Soft-tissue Reconstruction after High-voltage Electrical Burn Injuries

Martínez

Córdoba

Parra

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: This is the case of a 21-year-old man who had extensive and bilateral knee soft-tissue damage after a high-voltage electrical discharge. In its reconstruction, we simultaneously performed the pedicled medial sural artery perforator flap. Even though mild complications took place, this alternative proved helpful and reliable, providing an easily adjustable skin island and allowing for the patient’s rapid rehabilitation and a satisfactory aesthetic outcome. Although this flap’s reconstructive potential is known in other etiologies, the present report outlines its substantial potential in the case of electrical burn injuries, as it has barely been recognized before.

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Section: Discussionmentioning

confidence: 77%

Bilateral Knee Soft-tissue Reconstruction after High-voltage Electrical Burn Injuries

Martínez

Córdoba

Parra

2023

Plastic and Reconstructive Surgery - Global Open

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“…The ubiquitous audible Doppler can be tediously dragged over the entire MGM, 17 55 56 57 58 but care must be taken as the audio heard from the usually very superficial course of the intramuscular branches may be enhanced, thereby obscuring differentiation from the perforators themselves. 59 Computed tomography (CT) angiography 32 60 61 62 63 and color duplex ultrasound 27 32 64 may be beneficial means to show the course and origin of potential perforators—if available. A cheaper alternative may be just smartphone thermography to find “hot spots” after a “cold challenge” ( Fig.…”

Section: The Techniquementioning

confidence: 99%

“…If a second MSAP perforator exists, that can similarly be used separately as a retrograde perfused propeller flap to facilitate direct closure of the donor site. 63 …”

Section: Technical Variationsmentioning

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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“…We read with great interest the article by Scaglioni et al entitled “The Versatility of the Pedicled Medial Sural Artery Perforator Flap: From Simple to Its Chimeric Pattern and Clinical Experience with 37 Cases.” 1 The authors describe their institutional experience using the pedicled medial sural artery perforator flap in its simple and chimeric form for reconstruction of defects in three different regions. The authors used the chimeric design in 10 cases with a 97% success rate, keeping two perforators for two skin paddles or one perforator for the skin paddle and the other for muscle 1 It was interesting to notice that in five patients, one of the harvested skin paddles was used for donor-site closure, by which the need for skin graft was reduced. Although the anatomical predictability of the medial sural artery perforator (MSAP) flap is still challenging and an intramuscular dissection should be done to raise the flap, it remains a pliable and suitable alternative for other frequent flaps such as the radial forearm flap, with much lower donor-site morbidity.…”

mentioning

confidence: 99%