Pharyngoesophageal Reconstruction With the Medial Sural Artery Perforator Flap After Total Laryngopharyngectomy

Shen, Hongqiang; Shen, Xinyi; Lv, Ying; Xu, Jinghong; Lü, Hui

doi:10.1097/sap.0000000000000794

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“…The MSAP is becoming increasingly popular for head and neck reconstruction due to its versatility, thinness, pliability, long pedicle, and particularly favorable donor site. This flap has rarely been described in the otolaryngology literature, and the description and use of this flap is largely limited to plastic surgery and oral and maxillofacial literature . This may be in part due to the steep learning curve reported for this flap and the higher incidence of complications reported .…”

Section: Introductionmentioning

confidence: 99%

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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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“…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.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Taufique¹,

Daar

Cohen

et al. 2018

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…In addition, if one flap were buried, monitoring would be possible by externalizing the second. 71 Of course, since the MSAP flap is a "true" perforator flap, 16 the requisite musculocutaneous perforator is intimately attached to MGM branches so that a portion if not all of that muscle could be combined as a chimeric flap. If the intramuscular branching pattern were type II or III (►Fig.…”

Section: Adipofascialmentioning

confidence: 99%

“…Two small subfascial incisions at the anterior border of the MGM will allow passage of retractors and a 4-mm endoscope with a 30-degree angle for actual visualization of the perforator. 48 59 62 71 As an alternative, a small subfascial exploratory incision along the proposed anterior border of the flap with upward traction on the flap might be sufficient to lead to accurate citing of the perforator where it enters the deep fascia. 55 Once confirmed, the flap design should be revised as necessary.…”

Section: The Techniquementioning

confidence: 99%

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

Hallock

2022

Arch Plast Surg

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Rather than just another “review,” this is intended to be an “overview” of the entire subject of the medial sural artery perforator (MSAP) flap as has been presented in the reconstructive literature from its inception in 2001 until the present, with any exceptions not purposefully overlooked. Unfortunately, the pertinent anatomy of the MSAP flap is always anomalous like most other perforator flaps, and perhaps even more variable. No schematic exists to facilitate the identification of a dominant musculocutaneous perforator about which to design the flap, so some adjunctive technology may be highly valuable for this task. However, if a relatively thin free flap is desirable for a small or moderate sized defect that requires a long pedicle with larger caliber vessels, the MSAP flap deserves consideration. Indeed, for many, this has replaced the radial forearm flap such as for partial tongue reconstruction. Most consider the donor site deformity, even if only a conspicuous scar on the calf, to be a contraindication. Yet certainly if used as a local flap for the knee, popliteal fossa, or proximal leg, or as a free flap for the ipsilateral lower extremity where a significant recipient site deformity already exists, can anyone really object that this is not a legitimate indication? As with any perforator flap, advantages and disadvantages exist, which must be carefully perused before a decision to use the MSAP flap is made. Perhaps not a “workhorse” flap for general use throughout the body, the MSAP flap in general may often be a valuable alternative.

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

et al. 2019

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BackgroundThe 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.MethodsA 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.ResultsIn 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%).ConclusionsThe 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.

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Pharyngoesophageal Reconstruction With the Medial Sural Artery Perforator Flap After Total Laryngopharyngectomy

Abstract: Here, we demonstrated the use of the MSAP flap in reconstruction of circumferential pharyngoesophageal defects. Further application and follow-up studies should be performed.

Cited by 7 publications

References 12 publications

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

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

The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”

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

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