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

Hallock, Geoffrey G.

doi:10.1055/s-0042-1744425

Cited by 8 publications

(7 citation statements)

References 114 publications

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“…Perforators from median sural artery, lateral sural artery or further distally, and a posterior tibial artery perforator may be used as the basis of a flap from the same region. 17 In this study, the median sural artery pedicle could be dissected only in 29 cases as no perforator could be identified in 4 out of 33 legs. In 25 legs (86.2%), the median sural artery originated from the popliteal artery and in 4 of them (13.8%), it originated from a common sural trunk.…”

Section: Discussionmentioning

confidence: 90%

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A Cadaveric Study on Perforator Anatomy of the Medial Sural Artery Perforator Flap

Titus,

Sreedevi,

Parameswaran

et al. 2024

Indian J Plast Surg

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Background The medial sural artery perforator (MSAP) flap was described by Cavadas et al in 2001. The aim of this study was to analyze the flap characteristics in the regional population and was planned as a cadaveric dissection study. Methods Thirty-three legs of fresh cadavers were studied for perforator characteristics, length, and origin of pedicle and skin paddle thickness. Observations were documented and analyzed. Results Seventeen right legs (51.5%) and sixteen left legs (48.5%) were studied. Twenty-five pedicles originated from popliteal artery (86.2%) and four (13.8%) from the common sural trunk. No perforators were seen in four legs. The mean number of perforators is 2 (0–6). The mean distance of perforator from midpoint of popliteal fossa was 10.7 cm (8–13 cm) and from posterior midline it was 3.2 cm. The mean size of the perforator was 1.1 ± 0.8 mm (0.8–1.5 mm). The mean pedicle length was 9.3 ± 1.3 cm. The mean flap thickness was 4.3 ± 0.7 mm (3.0–5.5 mm). There was no correlation for flap or perforator characteristics with side of leg. Conclusion This study concludes that MSAP is a good flap in terms of perforator characteristics, pedicle length, and flap thickness, when a medium sized thin flap with long pedicle is needed. The location of perforator on calf varies in different population. Being a perforator flap, anatomical variability is common and should be thought of while choosing this flap.

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Section: Discussionmentioning

confidence: 90%

“…Perforators from median sural artery, lateral sural artery or further distally, and a posterior tibial artery perforator may be used as the basis of a flap from the same region. 17 …”

Section: Discussionmentioning

confidence: 99%

A Cadaveric Study on Perforator Anatomy of the Medial Sural Artery Perforator Flap

Titus,

Sreedevi,

Parameswaran

et al. 2024

Indian J Plast Surg

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“…Nevertheless, dissection generally improves with training and experience. [30] Hallock summarized the various methods of perforator identification [31]. Care should be taken when using an audible doppler as the audio heard can be of the very superficial course of the intramuscular branches and could be confused with the perforator themselves.…”

Section: Summary Of Study Findingsmentioning

confidence: 99%

“… 30 Hallock summarized the various methods of perforator identification. 31 Care should be taken when using an audible Doppler as the audio heard can be of the very superficial course of the intramuscular branches and could be confused with the perforator themselves. 31 Alternatively, both color duplex ultrasound and computed tomography angiography have proven instrumental in helping localize the perforators and thereby allowing for swifter harvest of the MSAP flap.…”

Section: Summary Of Study Findingsmentioning

confidence: 99%

The Medial Sural Artery Perforator Flap versus Other Free Flaps in Head and Neck Reconstruction: A Systematic Review

et al. 2023

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The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, EMBASE and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared to the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0% vs. 10.4%) but less donor-site complications (20.2% vs. 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps (P = 0.0006) but no statistical difference in speech and swallowing function following reconstruction (P = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.

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“…The musculocutaneous gastrocnemius flap, described in the early 70s by McCraw et al, has been recently rediscovered for knee reconstruction, with a new knowledge on skin perforator harvest possibilities (deriving from the sural artery system). 7,8 Such enhanced tailoring possibilities can expand flap potential for reconstruction, fully exploiting both muscle and skin components. 9,10 This study investigates knee reconstructions using chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) flaps in complex knee reconstruction where simple GM flap seemed insufficient, including recurring arthroplasty infections and extended sarcoma or traumatic defects.…”

Section: Introductionmentioning

confidence: 99%

Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls

Sapino,

Osinga,

Maruccia

et al. 2023

Arch Plast Surg

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Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee joint mobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous–medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller–perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

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

Cited by 8 publications

References 114 publications

A Cadaveric Study on Perforator Anatomy of the Medial Sural Artery Perforator Flap

A Cadaveric Study on Perforator Anatomy of the Medial Sural Artery Perforator Flap

The Medial Sural Artery Perforator Flap versus Other Free Flaps in Head and Neck Reconstruction: A Systematic Review

Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls

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