Applications of Medial Sural Perforator Free Flap for Head and Neck Reconstructions

Choi, Jong Woo; Nam, Soon Yuhl; Choi, Seung Ho; Roh, Jong Lyel; Kim, Sang Yoon; Hong, Joon Pio

doi:10.1055/s-0033-1343959

Cited by 31 publications

(3 citation statements)

References 12 publications

(14 reference statements)

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“…Choi et al described a case series of 20 patients with MSAP flap for oral cancer reconstruction of which two flaps failed, and an alternative flap had to be used [ 9 ]. The first case of flap failure was raised on a single very small diameter perforator which was confirmed to be pulsating although it was noted that the route of the pedicle had a very right-angled shape near the medial popliteal artery.…”

Section: Discussionmentioning

confidence: 99%

Medial sural artery perforator flap: a challenging free flap

Toyserkani

Sørensen

2015

Eur J Plast Surg

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BackgroundOral and extremity defect reconstruction can often require a flap that is thin, and traditionally, the radial forearm free flap has been used, however, this has significant donor site morbidity. Over the last decade, the medial sural artery perforator (MSAP) flap has emerged as a possible alternative with lower donor site morbidity. We present our experiences and review the literature regarding this promising but challenging flap.MethodsThe study was a retrospective case series in a university hospital setting. All patients who had a MSAP flap performed at our institution were included until March 2015, and their data was retrieved from electronic patient records.ResultsIn total, ten patients were reconstructed with a MSAP flap for floor of mouth (eight) and lower extremity (two) defect reconstruction. The median flap dimensions were as follows: 10 cm (range 7–14 cm), width 5 cm (range 3.5–8 cm), thickness 5 mm (range 4–8 mm), and pedicle length 10 cm (range 8–12 cm). In one case, the procedure was abandoned because of very small perforators and another flap was used. In two cases, late onset of venous congestion occurred which could not be salvaged. There were no donor site complaints.ConclusionsThe MSAP flap is an ideal flap when a thin free flap is needed with lower donor site morbidity than alternative solutions. There seems to be a higher rate of late onset of venous thrombosis compared with more established flaps. Therefore, this flap should be monitored more closely for venous problems and we recommend performing two venous anastomoses when using this flap.Level of Evidence: Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Medial sural artery perforator flap: a challenging free flap

Toyserkani

Sørensen

2015

Eur J Plast Surg

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“…In addition, tissue expansion has many limitations, including restricted expansion and relatively high complication rates of 10% to 80%. 8 Free flaps confer certain advantages over conventional local flaps, including the possibility of elevating a flap with extensive dimensions, and the potential to utilize multiple tissue components, such as the skin, fat, and muscle. However, because free flaps are harvested from distant areas of the body, differences in terms of skin color and texture are major disadvantages, particularly for reconstruction of the facial surface.…”

Section: Discussionmentioning

confidence: 99%

“…Because the perforator free flap technique has recently evolved, there are now several perforator free flaps available. Microsurgeons are increasingly turning to these new flaps 8 – 10 ; however, while the popularity of freestyle perforator-based free flaps has increased, so has the requirement to personalize the thickness of each perforator flap. Despite aggressive defatting procedures, the degree of flap defatting is limited so as to reduce the likelihood of marginal flap necrosis.…”

Section: Discussionmentioning

confidence: 99%

Extensive Facial Reconstruction Using Thickness-controlled Perforator Free Flaps

Choi

Park

Kim

2020

Plastic and Reconstructive Surgery - Global Open

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Background: Although small and medium facial defects can be reconstructed with local flaps to ensure skin color and texture matching, extensive facial defects require the application of free flaps, including perforator free flaps. We hereby propose a personalized strategy for facial reconstruction to overcome these limitations, based on the use of free flaps accompanied by local flaps and thickness-controlled perforator flap concept, for extensive facial defects. Methods: A series of consecutive facial reconstructions were performed from 2006 to 2016 in the Plastic and Reconstructive Surgery Department of our institution. Only extensive facial defects greater than 40 cm2 were included in this study. Results: A total of 323 patients underwent reconstruction using free flaps with or without local flaps, from November 2005 to March 2019. Of these, 79 extensive facial surface reconstruction cases were analyzed retrospectively. The size of the defects, their areas (upper, middle, or lower third of the face), and the method of reconstruction were analyzed. This led to the development of a personalized reconstruction procedure for extensive facial defects. These extensive facial reconstruction cases included 24 defects of the upper third of the face, 43 cases of the middle third, and 12 of the lower third. Four cases addressed the middle and lower thirds simultaneously. Conclusions: The facial surface reconstruction strategy I suggest in this study is based on the flap selection, thickness-controlled perforator flap elevation, and combination of local and free flaps. We expect this procedure will improve the treatment and resolution of extensive facial defects.

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The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

Taufique¹,

Daar

Cohen

et al. 2018

The Laryngoscope

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Objectives The medial sural artery perforator (MSAP) free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. We aim to describe the MSAP flap and compare it to other commonly used free flaps in the head and neck. Study Design Retrospective case series. Methods A retrospective review of all MSAP cases performed at New York University Langone Health was performed from July 2016 to November 2017. We examined the patients’ age, diagnosis, history of prior radiation therapy, and comorbidities, as well as flap‐specific information and recipient site. Results Twenty‐one patients underwent a variety of different head and neck procedures with coverage using an MSAP flap. Recipient sites included tongue, cheek, soft and hard palate, cervical esophagus, and pharynx. Pedicle length ranged from 8 cm to 12 cm. The smallest surface area harvested was 24 cm2 (6 cm × 4 cm), and the largest was 120 cm2 (15 cm × 8 cm). The flaps ranged from 5 to 12 mm in thickness. Venous coupler size ranged from 2.0 to 3.5 mm. Primary closure of the donor site was achieved in 18 of 21 flaps. Twenty of 21 flaps were transferred successfully. Conclusion The MSAP flap is a highly versatile and reliable option for a thin, pliable soft tissue flap with a donor site that may be preferable over the radial forearm free flap and anterolateral thigh flap in complex head and neck reconstruction. Level of Evidence 4 Laryngoscope, 129:1330–1336, 2019

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Applications of Medial Sural Perforator Free Flap for Head and Neck Reconstructions

Cited by 31 publications

References 12 publications

Medial sural artery perforator flap: a challenging free flap

Medial sural artery perforator flap: a challenging free flap

Extensive Facial Reconstruction Using Thickness-controlled Perforator Free Flaps

The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

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