Sural Artery Perforator Free Flap Research Articles

Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity.

Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life. All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed. The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05). The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF. The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.

Evaluation of Functional and Esthetic Outcomes in Oral Cancer Patients Reconstructed with Medial Sural Artery Perforator Free Flap

Evaluation of Functional and Esthetic Outcomes in Oral Cancer Patients Reconstructed with Medial Sural Artery Perforator Free Flap

Reconstruction of Head and Neck Defects Using Medial Sural Artery Perforator Free Flap.

To study the use of medial sural artery perforator(MSAP) free flap in head and neck reconstruction. This was a prospective study. The patients with cancers of head and neck underwent excision of tumor along with neck dissection, and MSAP free flap was used for reconstruction. The free MSAP flaps were used in 30 patients to reconstruct head and neck soft tissue defects. There were sixteen male and six female patients with the median age of 40 years. The most common site of tumor resection was the tongue (14 cases), followed by buccal mucosa (12 cases), neck skin(2 cases), skin over parotid(1 case) and lip(1 case). Average flap size was 56 cm2. Thickness of the flap ranged from 4 to 8mm. The length of the vascular pedicle ranged from 8 to 14cm (12cm mean) which provides sufficient length during vessel anastomosis. Arterial diameter ranged from 1.0 to 1.5mm(Average - 1.25mm) and venous diameter of both veins in pedicle ranged from 1.5 to 2.5mm(Average - 2mm) in size. Most flaps were based on two perforators. Primary closure was attained in 11 cases whereas 19 patients required split thickness skin graft(STSG). The average flap harvesting time was 45min. Flap was failed in two cases. MSAP is good alternative to FRAFF in the reconstruction of defect after resection of head and neck cancer.

The Medial Sural Artery Perforator Free Flap: A Novel, yet Challenging and Versatile Flap for Head and Neck Reconstruction.

Background In head and neck reconstruction, especially after cancer ablation, choosing the best flap is critical. Due to its thin, lengthy, and malleable vascular pedicle as well as low donor site morbidity, the medial sural artery perforator (MSAP) free flap is gaining popularity among reconstructive surgeons, particularly in oral soft-tissue reconstructions. The goal of this study was to record the clinical use of an MSAP flap in the repair of post-oncologic lesions in the head and neck region. Methodology Patients with oral cancer who came to our center after ablative surgery on the buccal mucosa, tongue, floor of the mouth, and hard palate were repaired utilizing the MSAP flap. Preoperatively, the perforators were discovered using an 8 MHz portable doppler and a computed tomography angiogram. Without the use of a tourniquet, the flaps were delineated and harvested. In all of our patients, a single venous anastomosis was sufficient. Results The MSAP flap was used to positively rebuild 14 cancer patients, with the flap design based on the amount of the resection site or defect. The buccal mucosa (n = 7) and tongue (n = 6) were the most common subsites of the ablative defect. The average flap size was 12 × 6 cm, with a thickness of 5-7 mm. In eight cases, the donor site defect was mostly closed, with the remaining patients receiving split-thickness grafts for subsequent healing. In 12 cases, the best cosmetic and functional results were obtained. One patient developed a postoperative wound infection, and the flap could not be saved. Another patient developed a neck hematoma which had to be debrided on the second postoperative day, with good results. In primary closure cases, patients were mobilized with full weight-bearing on the first postoperative day. Conclusions MSAP flap is an alternative to radial forearm free flap and anterolateral thigh flap in obese patients with medium-sized oral abnormalities. This flap stands out as an outstanding option for head and neck soft-tissue reconstruction due to its unique mix of flap thinness, greater skin region, and superior donor site cosmesis. Despite its importance, just a few case studies and reports have been published. A multicenter trial with a high sample size would demonstrate the use of this flap and its chimeric designs.

USING MEDIAL SURAL ARTERY PERFORATOR FLAP IN RECONSTRUCTION OF LIMB SOFT TISSUE DEFECTS

Aims: To evaluate the results of covering limb soft tissue defects with medial sural artery perforator free flap. Materials and Method: Non-randomised interventional study was performed on 10 cases of limb soft tissue defects exposing tendons, bones, blood vessels or nerves covered by medial sural artery perforator free flap. The lesion characteristics and flap features have been described. The effectiveness of defect coverage and the impact of the donor site were evaluated at the time of hospital discharge and 3 months after surgery. Results: 7 soft tissue defects of the lower limbs and 3 defects of the fingers, exposing tendons and bones were included in research. The average size of flaps was 5.9x11.2 cm2, the average thickness of flaps was 10.2±2.1mm, the average length of vessel pedicles was 10.3±2.6 cm and there were average of 1.9 perforators per flap. No postoperative complications were recorded. 100% of the flaps survived and covered the defects complettly. 100% of the donor sites were closed directly. After 3 months, 8/10 patients showed good limb function, 2/10 patients suffered from limited function at recontructed limb due to severe primary injury despite of good results in covering and healing. 7/10 flaps were flat, 3/10 flaps were thicker than expectation. 100% of the donor sites showed normal function. Although 6/10 cas appeared hypertrophic scars and 7/10 cas showed hyperpigmentation but all of the patients were sactisfied. Conclusions: The medial sural artery perforator flap has the advantages of being thin, less morbidity at the donor site and being suitable for medium soft tissue limb defects. Key words: Soft tissue limb defects, medial sural artery perforator flap, free flap.

The chimeric medial sural artery perforator flap as the ideal for partial tongue reconstruction: A case series and technical refinements

The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction. A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap. A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8 mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented. The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction.

The Usefulness of Medial Sural Artery Perforator Free Flap for Head and Neck Reconstruction

Background and Objectives The ideal flap for head and neck reconstruction should be pliable, have sufficiently long pedicle and minimize donor defects. Anterolateral thigh free flap (ALTFF) and radial forearm free flap (RFFF) have been the workhorse flaps for head and neck reconstruction. However, ALTFF is too bulky and RFFF leaves a conspicuous scar on the donner site. Medial sural artery perforator free flap (MSAPFF) is a possible alternative, which has the benefit of thin RFFF and low donor site morbidity of ALTFF. Here, we evaluated for the first time the usefulness of MSAPF for head and neck reconstruction in Korean patients. Subjects and Method We carried out a retrospective study of patients who underwent MSAPFF for head and neck reconstruction from October 2018 to July 2019 by retrieving their data from electronic medical records. Patient characteristics, flap characteristics, surgical outcomes, and complications of donor sites were analyzed. Results Eight patients underwent MSAPFF reconstruction after head and neck surgery. The recipient sites were the following: the floor of the mouth, palate, tongue, the base of the tongue and nasolabial fold. The average median flap size was 34.1 cm2 (range 17.5-50 cm2), length 7.1 cm (5.0-10.0 cm), width 4.7 cm (range 3.5-5.0 cm), and pedicle length 9.2 cm (range 8-10 cm). There was one flap failure because of pedicle arterial insufficiency. All donor sites were closed primarily without any complication. Conclusion Based on the findings of this study, MSAPFF may be a new workhorse flap because it has thin, pliable tissue with low donor-site morbidity for head and neck reconstruction.

Popliteal fossa reconstruction with a medial sural artery perforator free flap using the medial sural vessel as the recipient

Background: Reconstruction of the popliteal fossa using a free flap is challenging. Therefore, to facilitate easier free flap reconstruction of the popliteal fossa, we use a medial sural artery perforator (MSAP) free flap with a medial sural vessel as the recipient vessel, as it provides several advantages based on many reports.Methods: This report describes the authors’ experience and outcomes with this technique. Between October 2010 and January 2015, 10 patients with medium-sized defects in their popliteal fossa underwent MSAP free flap reconstruction using the medial sural vessel as the recipient vessel. The flap size and thickness were evaluated, as well as the pedicle length, for each case.Results: The skin flap sizes ranged from 60–112 cm2. The average flap thickness was 6 mm (range = 4–8 mm), and the average pedicle length was 7.5 cm (range = 6–9 cm). Full flap survival was observed in nine cases, and flap tip necrosis was observed in one case during a mean follow-up of 15 months (range = 3–36 months). MSAP free flap reconstruction was performed for moderate-sized defects in the popliteal fossa, using the medial sural vessel as the recipient vessel.Conclusion: The obvious advantages of this technique included simple vascular anastomosis (minimal size discrepancy), no intraoperative position changes, and good aesthetic outcomes (replacing like with like).

Medial Sural Artery Perforator Free Flap: Legitimate Use as a Solution for the Ipsilateral Distal Lower Extremity Defect

The medial sural artery perforator (MSAP) flap captures the cutaneous territory of the medial calf, and can potentially be advantageous as a thin free flap, even in the most obese individual, for coverage of most foot and/or ankle defects where bulk is a liability. The anatomy is fairly constant, as usually at least one reasonably large perforator can always be found emanating from the medial head of the gastrocnemius muscle. As a microsurgical tissue transfer, a long vascular pedicle of large caliber is routinely possible which facilitates any requisite microanastomoses.Over the past decade from our free flap registry, 14 patients with distal lower extremity wounds were covered specifically with a perforator flap based on the ipsilateral medial sural artery; out of which only 2 (14%) were females.In this series using a MSAP free flap, there was only one failure requiring salvage by a different free flap. All but one case was a sequel of trauma, and these involved all zones of the foot and ankle. A skin graft of the donor site was necessary in 5/14 (36%) patients. In no cases did the flap subsequently impede the use of shoes nor hinder ambulation.The study concluded the major disadvantage of the MSAP flap is the nonaesthetic scar left at the donor site which can be quite conspicuous, especially if a skin graft had to be used. Yet even this detriment can be acceptable for ipsilateral distal lower extremity defects where reconstruction of the defect itself may be cosmetically unappealing. This may be the best indication for the MSAP flap to be considered first as the free flap of choice.

Plantar Reconstruction Using the Medial Sural Artery Perforator Free Flap

Free flaps are usually required rather than local flaps for large plantar defects, due to a lack of locally available tissue. The medial sural artery perforator free flap, recently introduced clinically by several authors, is a noticeable option for soft tissue coverage, but it has still not been widely used for the reconstruction of various large plantar defects. Between 2005 and 2007, medial sural artery perforator free flaps were used to reconstruct soft tissue defects in plantar areas in 11 patients at our institute. Patient ages ranged from 10 to 68 years (mean, 43 years), and follow-up periods ranged from 7 to 22 months (mean, 13 months). Flap sizes ranged from 10 to 14 cm in length and from 5 to 7 cm in width. Flaps survived in all patients. Marginal loss over the distal flap region was noted in 1 patient, and this was treated successfully with a subsequent split-thickness skin graft. In another one case, venous insufficiency developed, but salvage was successful with leech application. Long-term follow-up showed good flap durability with a protective sensation. The medial sural artery perforator flap provides sufficient durability for weight-bearing areas, even though it is a thin cutaneous flap. The authors recommend that this flap be considered as a reliable alternative for the reconstruction of large plantar defects.

Clinical Experience with the Medial Sural Artery Perforator Free Flap

Clinical Experience with the Medial Sural Artery Perforator Free Flap

The Medial Sural Artery Perforator Free Flap

Cavadas, Pedro C. M.D., Ph.D.; Sanz-Giménez-Rico, Juan R. M.D.; la Cámara, Arturo Gutierrez-de M.D., Ph.D.; Navarro-Monzonís, Angel M.D.; Soler-Nomdedeu, Santiago M.D.; Martinez-Soriano, Francisco M.D., Ph.D. Author Information