Vascular anatomy of the medial sural artery perforator flap: A new classification system of intra-muscular branching patterns

Dusseldorp, Joseph R.; Pham, Quy J.; Ngo, Quan; Gianoutsos, Mark P.; Moradi, Pouria

doi:10.1016/j.bjps.2014.05.016

Cited by 50 publications

(56 citation statements)

References 21 publications

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“…The rows generally unite long before the popliteal crease [11]. Whether cadaveric or clinical previous literature reveal that most perforators are located in the medial calf area within 9-18 cm from popliteal crease, number ranged from one to four but generally two dominant perforators are identified [12]. Kao et al founded the mean number of total perforators was 2.7-1.5 (range [1][2][3][4][5], and the mean number of large perforators was 1.6-0.7 (range 1-3) [13].…”

Section: Discussionmentioning

confidence: 97%

Medial sural artery perforator flap in head and neck reconstruction

Ozkan

Irkoren

Aydin

et al. 2016

Eur Arch Otorhinolaryngol

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Medial sural artery perforator (MSAP) flap is a relatively new flap which is a modification of medial gastrocnemius myocutaneous flap. Both radial forearm flap and MSAP has common benefits, such as thinness, long pedicle and pliability; however, MSAP has lower donor site morbidity when compared with radial forearm flap. Because of this reason, the MSAP flap has gained popularity during the last decade. The objective of this study was to determine clinical application results of this flap in reconstruction of post-oncologic defects in the head and neck region. 11 patients operated for head and neck post oncologic defects and reconstructed with MSAP between June 2014 and Dec 2015 were included in the study. Age, gender, histopathology, area of reconstruction, flap size, number of perforators were reviewed. Postoperatively recipient and donor site complications, hospital stay and additional surgical procedures were also analyzed. We had seven uncomplicated cases; one total flap failure due to arterial problem, in three cases due fistula formation and local wound healing problems additional surgeries were performed. All venous anastomosis were performed with 9/0 sutures, nine arterial anastomosis were performed with 9/0 and two arterial anastomosis were performed with 10/0 nylon sutures. Medial sural artery perforator flap is a good alternative in head and neck reconstruction, with the advantages of thin and pliable skin, a reliable vascular pedicle, straightforward intramuscular dissection. But there are certain drawbacks like tedious pedicle and perforator dissection, small arterial pedicle size which complicates anastomosis and obscurities of anatomy. Surgical team must always be ready for a difficult micro anastomosis and an alternative flap choice must be prepared and counseled with the patient in case of inadequate perforators.

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Section: Discussionmentioning

confidence: 97%

Medial sural artery perforator flap in head and neck reconstruction

Ozkan

Irkoren

Aydin

et al. 2016

Eur Arch Otorhinolaryngol

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“…Additionally, branch takeoff points vary and can be located above or below the tibial plateau. 10 The MSAP flap, like the anterolateral thigh flap, provides ample tissue to accommodate a large opening at the proximal anastomosis without any tension, and the well-vascularized fascia and occasional inclusion of a segment of the vastus lateralis muscle provide an extra layer of closure, suggesting the fistula should not be a significant complication associated with this technique. FIGURE 2.…”

Section: Discussionmentioning

confidence: 99%

Pharyngoesophageal Reconstruction With the Medial Sural Artery Perforator Flap After Total Laryngopharyngectomy

Shen

Lv³

et al. 2017

Annals of Plastic Surgery

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Section: Discussionmentioning

confidence: 99%

“…A recent literature review has demonstrated a major MSAP being present in 98% of limbs (162 of 166 limbs), most often arising from the distal half of the medial head of gastrocnemius . In contrast, the lateral SAPs were found to be of too small a caliber to be of use . Venous drainage of the posterior calf skin parallels the perforators, however, in the midline, and most often in the case of the median sural artery, there is communication with the short saphenous vein …”

Section: Discussionmentioning

confidence: 99%