The Free Medial Sural Artery Perforator Flap (MSAPF): An Indispensable Tool for Head and Neck Reconstruction.

Abstract

Modern head and neck surgery is characterized by its emphasis on three important objectives of reconstructive and rehabilitative procedures-cosmesis, function and coverage of vital structures. Reconstruction with free flaps is a necessity when the defects become too large for more simple reconstruction options such as skin grafting and local flaps. The medial sural artery perforator flap (MSAPF) is a thin flap with a long pedicle. It has tremendous potential for applications in small-to-moderate soft tissue defects. Furthermore, chimeric MSAPF includes a skin paddle and a separated piece of medial gastrocnemius muscle, allows more freedom for flap insetting especially in 3-D reconstruction. The aim was to study the assessment of feasibility of MSAPF for head and neck reconstruction. Prospective case study from January 2019 to December 2019 was carried out in oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa and floor of the mouth which was reconstructed using MSAPF after oncologic resection. We reconstructed 20 patients using MSAPF. It was designed according to the size and site of the defect. Donor site was primarily closed in all cases. Great results were obtained. Out of 20 MSAP, 19 flaps survived. Flap failed in one case due to venous thrombosis. The thickness of the flap ranged from 4-9 mm, pedicle length ranged from 8-13mm, number of perforators ranged from 1-2, arterial diameter ranged from 1.5-2 mm and venous diameter ranged from 1-3mm. MSAPF is a good alternative for head and neck reconstruction with the advantages of thin and pliable skin, a long and reliable vascular pedicle, straightforward intramuscular dissection, the possibility of chimeric flap design and minimal donor site morbidity.