Medial sural artery perforator flap in head and neck reconstruction

Abstract

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.

Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis

“…After full‐text revision, 99 studies were excluded for several reasons. Thus, 32 studies were included for further investigation, all of which were published in English (Acar et al, 2015; Agrawal et al, 2018; Chen et al, 2010; Cheng et al, 2006; Choi et al, 2013; Ciudad et al, 2021; Grover et al, 2014; Hembd et al, 2018; Hubmer et al, 2011; Ito et al, 2016; Kamali et al, 2017; Kao et al, 2010; Karaaltin et al, 2011; Lee et al, 2019; Lee & Mun, 2008; Lin et al, 2006, 2008, 2009; Mosahebi et al, 2008; Mulvey et al, 2013; Mun et al, 2008; Özkan et al, 2016; Satish & Baliarsing, 2011; Scaglioni, Fakin, et al, 2016; Scaglioni, Kuo, et al, 2016; Suffee et al, 2015; Sun et al, 2011; Tang et al, 2013; Taufique et al, 2019; Wang et al, 2013, 2019; Yang et al, 2006). We followed the PRISMA guidelines and illustrated the study selection using the PRISMA flow diagram (Figure 1).…”

Do medial sural artery perforator flaps have better clinical outcomes compared to the rectus abdominis perforator (DIEAP) flap in reconstruction of glossectomy defects? A Prisma guided meta-analysis

“…Özkan et al [ 18 ] reviewed the clinical applications of MSAP flap in head and neck reconstruction. The study included 1 case of hemiglossectomy and 1 case of total glossectomy.…”

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

“…The same surgical method was used in each case, similar to the surgical technique already reported in previous studies . A two‐team approach was used in each case.…”

“…The MSAP is based on the gastrocnemius muscle flap because its perforator derives from the same source vessel (i.e., popliteal artery) while sparing the gastrocnemius muscle . It has both the long pedicle and low donor‐site morbidity of an ALT flap and thinness and pliability of the RFFF, which makes it an ideal microvascular flap for the challenging reconstruction needs often encountered in the head and neck from large oncologic defects, fistula repair, or pharyngeal stenosis repair.…”