Free Medial Sural Artery Perforator Research Articles

Management of breast cancer—related lymphedema using free medial sural artery perforator (MSAP) flap: a VLVT approach

Management of breast cancer—related lymphedema using free medial sural artery perforator (MSAP) flap: a VLVT approach

The Free Medial Sural Artery Perforator Flap for Microsurgical Reconstruction of Limbs: A Systematic Review and Meta-Analysis of Flap Characteristics and Outcomes

The medial sural artery perforator (MSAP) continues to gain popularity. Providing a versatile, thin and pliable alternative for commonly used workhorse flaps, it can be used to reconstruct extremities, with reduced donor site morbidity. This meta-analysis was conducted to analyse the current literature to help identify flap characteristics and outcomes. A systematic review was performed following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and a literature search was conducted using Medline, Google Scholar and the Cochrane Library. The aim was to identify the outcomes of free MSAP flap reconstructions of upper and lower limb defects over a 10-year period from January 2010 to July 2020. The data was then tabulated and a meta-analysis was carried out. A total of 11 studies for lower limbs and 7 studies for upper limbs were reviewed and analysed with a total number of 257 patients. Limb reconstructions were primarily due to trauma. The most common site of reconstruction of the upper limb was the hand or wrist and the lower limb was the ankle or feet. The mean length of the flap was 9.6 cm. The mean width was 5.4 cm. The mean pedicle length was 9.7 cm. The mean flap thickness was noted as 5.9 mm. The number of perforators was an average of 1.5. The pedicle’s mean arterial diameter was 1.9 mm (mean) and the vein’s mean arterial diameter was 2.9 mm. 80% of donor sites were closed directly. Overall, the flap success rate was 98%. Our results find the MSAP flap to be a versatile, reliable, functionally and aesthetically good reconstructive option for both lower and upper limb defects with low donor site morbidity.

Comparison of the free thinned anterolateral thigh perforator flap and the free medial sural artery perforator flap for reconstructing head, neck and extremity defects

BACKGROUNDThe free anterolateral thigh (ALTP) and free medial sural artery perforator (MSAP) flaps are time tested donor for head and neck, and extremities defect reconstruction. Proponents of either flap have concluded each as workhorse flap in their large cohort studies. However, we could not find any literature comparing the donor morbidities, or recipient site outcomes of these flaps, objectively.METHODSRetrospective data, such as demographic details, flap characteristics and post operative course, from patients who underwent free thinned ALTP (25 patients) and MSAP flap (20 patients) were included. At follow-up, donor site morbidity and recipient site outcomes were assessed, using previously defined protocols. These were compared in-between the two groups. RESULTSFree thinned ALTP (tALTP) flap had significantly more pedicle length and vessel diameter and harvest time than free MSAP flap (p value<.00). The differences in incidence of hyperpigmentation, itching, hypertrophic scar, numbness, sensory impairment and cold intolerance at the donor site in-between the two groups, were not significant statistically. Scar at free MSAP donor site was considered a significant social stigma (p value=.005). Recipient site cosmetic outcome was comparable (p value=.86), measured using aesthetic numeric analogue.CONCLUSIONSThe free tALTP flap is superior to free MSAP flap in terms of pedicle length, vessel diameter, donor site morbidity, while the latter takes lesser time for harvest.

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

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.

The basic anatomy of the medial sural artery perforator flaps in Vietnamese adults

BackgroundBoth free medial sural artery perforator flaps and pedicled medial sural artery perforator flaps have been being effectively used in treatment of body defects especially in head and neck region by plastic surgeons worldwide. However, there is a lack of comprehensive studies on the anatomy of perforating artery branches in Vietnam. This study aims to describe anatomical vascular pedicles of medial sural artery perforator flap in Vietnamese adults. MethodsA descriptive cross-sectional study, dissected 62 lower limbs of 41 Vietnamese adult cadavers preserved by formalin in Department of Anatomy, Hanoi Medical University and Ho Chi Minh Medicine and Pharmacy University. ResultsOrigin of medial sural artery was branched constantly from popliteal artery. Common stem of artery was 8.39 ± 3.5 cm in mean length. The diameter of common stem, which was measured from origin, was 2.88 ± 0.98 mm averagely. The common stem of artery, which did not have any branch (15%), divided in to 2 branches (15%), 3 branches (30%), 4 branches (40%) before entering muscle. Medial sural artery had 1 to 5 branches perforating to the skin. The distance from perforating branch to the knee joint (popliteal crease) was 10.12 ± 3.7 cm, the distance from perforator branch to middle posterior leg was 1.6 ± 0.96 cm. ConclusionsThe medial sural artery constantly originates from popliteal artery, supplies blood for medial gastrocnemius muscle. The skin area covering this muscle is nourished by one of five perforators of the medial sural artery. The perforating flaps can be created using medial sural artery perforating branches.

Comparison between Free Anterolateral Thigh Flap and Free Medial sural Artery Perforator Flap in Reconstruction of Posttraumatic Soft Tissue Defects of Dorsum of the Foot

Comparison between Free Anterolateral Thigh Flap and Free Medial sural Artery Perforator Flap in Reconstruction of Posttraumatic Soft Tissue Defects of Dorsum of the Foot

Comparison Between Free Anterolateral Thigh Flap and Free Medial Sural Artery Perforator Flap in Reconstruction of Post Traumatic Soft Tissue Defects of the Dorsum of the Foot

Abstract Background: The objective of this study is to compare between the free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot as regard the function, the aesthetic outcome, the complications and the patient satisfaction.Method: The study was conducted on 40 patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were allocated randomly into two groups. In group1 (20 patients), the defect was reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap.Result: In group 1 (ALT flap), Complete flap survival was achieved in all cases. Thirteen patients required secondary debulking procedures and scar revisions.In group 2 (MSAP Flap), Complete flap survival was achieved in 17 cases with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement.Conclusion: MSAP flap is good alternative in soft tissue reconstruction of the dorsum of the foot. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. ALT flap is better than MSAP flap in larger defects coverage but may need secondary debulking procedures or primary thinning at the time of reconstruction.

Comparison between Free Anterolateral Thigh Flap and Free Medial Sural Artery Perforator Flap in Reconstruction of Post Traumatic Soft Tissue Defects of Dorsum of the Foot

Background: The objective of this study was to compare the pliability, the function, aesthetic outcome, complications and patient satisfaction between free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot. Method: The study was conducted on forty patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were divided randomly into two groups. In group1 (20 patients), the defects were reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in 100% of cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 85% with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is superior to ALT flap. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases.

Reconstruction of thumb defects with medial sural artery perforator flap: case series.

BackgroundDigital defect is one of the most common types of emergency hand injuries. Plastic surgeons continue to search for a better method to repair digital defects, especially those of the thumb. The medial sural artery perforator (MSAP) flap has been widely used as a popular method for limb and head reconstruction. Our findings have led us to advocate the use of free medial sural artery perforator flap to repair large thumb defects.MethodsFrom July 2010 to July 2013, we used free MSAP flaps to resurface large defects of 9 thumbs in 9 clinical cases. There were 6 men and 3 women among the participants, aged 21–49 years (average age: 37.6 years). Flap sizes varied from 2 cm × 3 cm to 3 cm × 6 cm. Perforators of all flaps were accurately located by color Doppler detection.ResultsAccording to color Doppler detection, the distance from the popliteal crease to the points where first/second perforator pierced the deep fascia was 10.1±1.1/15.2±0.8 cm. The distance from the midline to the first/second perforator was 2.8±0.8/3.5±0.5 cm. A total of nine flaps fully survived. All defects of the nine thumbs were adequately resurfaced. Postoperative follow-up conducted at 12–24 months revealed satisfaction in both cosmetic and function results.ConclusionsThe MSAP flap, which can be easily harvested and well thinned, is an ideal choice to repair thumb defects. Accurate location of the perforator by Doppler detection ensures the surgical success, and minimizes injury to the donor site.

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

Defects in the knee area, popliteal fossa region, and upper third of the lower extremity can pose a challenge for reconstructive plastic surgeons. The purpose of this article is to report the authors' experience with the use of the pedicled medial sural artery perforator flap in its simple and chimeric form for reconstruction of defects in three different regions: knee, popliteal fossa, and proximal lower leg. From April of 2018 to April of 2019, 37 patients (29 men and eight women) with a mean age of 51 years (range, 18 to 78 years) underwent reconstruction with 37 pedicled medial sural artery perforator flaps. All flaps were harvested as pedicled perforator flaps in conventional or chimeric fashion and were based on one or two perforators. The defect locations included the knee (18 cases), popliteal fossa (seven cases), and proximal lower leg (12 cases). The cause of reconstruction was trauma in 22 patients (59 percent), tumor in 10 patients (27 percent), and donor-site closure of free medial sural artery perforator in five patients (14 percent). The flap sizes varied from 3.5 × 5 cm to 5 × 10 cm. All but one flap, which showed distal tip necrosis, survived completely after surgery. The donor sites were all closed primarily. Minor complications included flap dehiscence (two cases) and minor wound infection delaying the healing process (four cases). All complications were treated conservatively. Follow-up observations were conducted for 3 to 12 months, and all patients had good functional recovery with satisfactory cosmetic results. The pedicled medial sural artery perforator flap can be considered an optimal method of reconstruction for covering defects not only in the knee area but also in the popliteal fossa and upper lower leg. Therapeutic, IV.

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

The 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. A 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. In 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%). The 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.

Technical refinements of the free medial sural artery perforator (MSAP) flap in reconstruction of multifaceted ankle soft tissue defects

BackgroundPeri-ankle defects are difficult to reconstruct due to sharp contours, thin skin, aesthetic value, function and footwear impact. The medial sural artery perforator flap (MSAP) is increasing in popularity as a thin and pliable flap. This study aims to demonstrate its versatility in reconstructing defects around the ankle area and our approach to insetting these flaps in difficult areas around the ankle without the need for subsequent flap revisions. MethodsA retrospective review of the senior author’s series of peri-ankle reconstructions using the MSAP flap was undertaken. ResultsBetween 2011–2015, 15 patients underwent peri-ankle reconstruction with the MSAP flap. There were 4 dorsal foot, 4 medial malleolar, 4 lateral malleolar, and 3 tendo-achilles defects. All flaps in this series survived. There was one episode of partial flap necrosis in one patient and no incidences of donor site dehiscence. All patients returned to full ambulation and none required subsequent flap revision. ConclusionsThe MSAP flap offers the benefits of a fasciocutaneous flap, whilst providing a thin, pliable, single stage and robust reconstruction for peri-ankle defects, with a cosmetically ideal donor site.

Tongue reconstruction after hemiglossectomy with the Free Medial Sural Artery Perforator Flap

Tongue reconstruction after hemiglossectomy with the Free Medial Sural Artery Perforator Flap

Application of free medial sural artery perforator flap for repair of severe thumb web scar contracture

Objective To explore the clinical effect of free medial sural artery perforator (MSAP) flap for repair of severe thumb web scar contracture. Methods From October 2012 to March 2015, 14 cases of severe thumb web scar contracture were repaired with free MSAP flap after scar excision. The flap areas ranged from 5 cm×4 cm to 9 cm×6 cm. The clinical outcomes were evaluated by the appearance of transplanted flaps, sensory recovery, opening angle and width of thumb web and donor site recovery at postoperative follow-up. Results All 14 flaps survived uneventfully. The thumb webs were well-stacked with satisfactory shapes. There was no secondary contracture. Primary healing was achieved at donor sites. Postoperative follow-up ranged from 12 to 18 months, with an average of 14 months. Postoperative angle of repaired thumb webs was enlarged to (80±6)° from preoperative angle of (15±5)°. And the width was enlarged to (45.0±5.6) mm from (20.0±3.5) mm. Thumb functions of abduction, adduction and opposition were all improved obviously. All flaps restored protective sensation. Six cases with anastomosis of medial sural cutaneous nerve recovered to S3. No functional damage was observed at donor sites. Conclusion MSAP flap is an effective way to repair severe thumb web contracture because of its constant perforator, satisfactory shape of repaired thumb webs and minor damages to donor sites. Key words: Surgical flaps; Transplantation; Medial sural artery perforator; Thumb web contracture

Medial sural artery perforator flap in tongue reconstruction

Background and objectives: Different free flaps have been used to reconstruct medium-sized defects in tongue after cancer ablation. Traditionally, radial forearm free flap was considered the workhorse in soft tissue intraoral reconstruction. More recently, free medial sural artery perforator flap (MSAPF) has been used as an alternative. The authors investigated the outcome and donor-site morbidity of MSAPF for tongue reconstruction.

The medial sural artery perforator flap and its application in electrical injury to the hand

We describe the use of a free medial sural artery perforator flap to reconstruct a complex composite defect to the dorsum of the right index finger following a low voltage electrical injury. The resulting defect was a 3.5 × 5 cm full thickness wound, with segmental tendon loss and loss of underlying periosteum. Due to both size and local vascular injury related to the mechanism, free tissue transfer was felt to be the most reliable option to resurface the composite defect in a single stage. The medial sural artery perforator flap, for reasons outlined below, was felt to be the best option: 1. Thin profile. 2. Vascularised fascia can be taken as a tongue, adjacent to the skin paddle: a gliding surface to prevent the tendon graft sticking to exposed bone. 3. Long pedicle: micro-anastomosis away from zone of injury. 4. Little donor site morbidity: can be closed directly (if <6 cm wide) and does not require sacrifice of any major blood vessel. 5. Can be harvested with nerve and tendon from the same wound. 6. Can include as little or as much tissue required and compared to other fasciocutaneous flaps matches the texture and thickness of the hand most closely. We describe the reconstruction of the composite defect on day 42 post-injury, following one prior debridement. This case highlights the versatility and suitability of the medial sural artery flap in the reconstruction of complex hand burns with resulting composite defects.

Reconstruction of Distal Limb Defects with the Free Medial Sural Artery Perforator Flap

Reconstruction of Distal Limb Defects with the Free Medial Sural Artery Perforator Flap

OP155: Medial sural artery perforator flap for oral and maxillofacial reconstruction following tumor resection

To explore the application of the medial sural artery perforator flap to reconstruct the defect following oral and maxillofacial tumor resection. Between April, 2010 and April, 2011, the oral and maxillofacial defects after tumor resection were reconstructed with free medial sural artery perforator flaps in 21 patients (11 men and 10 women) in our department. Patient ages ranged from 33 to 71 years (mean, 54 years) and follow-up periods ranged from 1 to 12 months (mean, 5 months). The clinical data were collected, including the size of skin paddle, the number of major perforators (vein >1 mm), the length of pedicle and the donor-site morbidity. We paid attention to the outcome and donor-site morbidity after reconstruction. The medial sural artery perforator flap flaps were raised with 1–4 perforators. One flap was partial lost after reexplored due to venous thrombosis. All of the other 20 flaps succeeded. Flap sizes varied from 4 × 6 cm to 6 cm × 12 cm. The mean length of the pedicle was 10.6 cm. Long-term follow-up showed satisfying receipt-site reconstruction result was gotten with good functional and cosmetic outcome in the donor site. The advantages of minimizing donor site morbidity were due to maintain the function of the muscle, avoid sacrificing major artery of the leg and closing the donor defect directly. The medial sural artery perforator flap is a good and reliable alternative to reconstruct the small to medium-sized defect in oral and maxillofacial region with less donor site morbidity.

Reconstruction of Distal Limb Defects with the Free Medial Sural Artery Perforator Flap

The medial sural artery perforator flap is a reliable cutaneous flap that can be used for soft-tissue reconstruction in the extremities. The purposes of this article are to fully document the vascular basis of the medial sural artery flap and to report its use in reconstruction of distal extremities. Ten fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using a spiral computed tomography scanner and specialized software (Materialise Interactive Medical Image Control System). The origin, course, and distribution of the medial sural artery perforator in the posterior leg region were observed. Between April of 2007 and December of 2010, the authors used the free medial sural artery perforator flap for distal limb reconstruction in 34 clinical cases. Flaps size varied from 5.5 × 4.5 cm to 14 × 9 cm. The average diameter of medial sural artery perforators was 0.9 ± 0.2 mm, with each perforator supplying an average territory of 55 ± 20 cm. Extensive anastomoses were found between the medial sural artery perforators and multiple adjacent source arteries. Twenty-nine flaps (85.3 percent) fully survived and five (14.7 percent) underwent partial necrosis. Follow-up observations were conducted for 6 to 21 months, and the cosmetic results were satisfactory and without apparent bulkiness. The free medial sural artery perforator flap transfer is appropriate for extremity defect reconstruction. The donor site not only supplies a thin skin flap but also provides the option to harvest a cross-boundary perforator flaps that could be useful for repairing widespread traumatic soft-tissue defects. Therapeutic, IV.

A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation

To investigate the application of free medial sural artery perforator flap to reconstruct the defect following head and neck tumor ablation. From April 2010 to January 2011, the defects after head and neck tumor resection were reconstructed with free medial sural artery perforator flaps in 16 patients. The clinical data were collected and analyzed, including site and histology of tumor, the skin paddle's size of the flap, the length of pedicle, the number of major perforators and donor-site morbidity. Medial gastrocnemius territories were evaluated before operation and free medial sural artery perforator flaps were used to reconstruct the defect after tumor ablation in 16 cases. One flap partially survived due to venous thrombosis. All of the other 15 flaps succeeded. The donor site was primarily closed in 15 cases and skin graft was applied in one case. All donor sites except one case healed in first intention. Long-term follow-up showed satisfying receipt-site reconstruction results with good functional and cosmetic outcome in the donor site. There was only minor sensory deficit in the donor site. The medial sural artery perforator flap is reliable for reconstruction of the small to medium-sized defect in head and neck region with less donor site morbidity.