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

Abstract

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

In Reference to The Medial Sural Artery Perforator Flap: A Better Option in Complex Head and Neck Reconstruction?

“…We read with great interest the article titled "The Medial Sural Artery Perforator Flap: A Better Option in Complex Head and Neck Reconstruction?" by Taufique et al 1 We agree this is an important flap for the head and neck reconstructive microsurgeon to have in their armamentarium due to its increased versatility and improved donor site compared to the workhorse radial forearm flap (RFF). However, we understand a surgeon's hesitancy to incorporate a new flap that could be unreliable, 2 when there is a tried and true option with potentially acceptable downsides, such as donor site morbidity.…”

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).…”

“…Furthermore, no significant differences were found in the subgroups. Seven studies (Acar et al, 2015; Karaaltin et al, 2011; Lee et al, 2019; Lin et al, 2008; Mosahebi et al, 2008; Taufique et al, 2019; Wang et al, 2019) involving 356 flaps (144/212) were included when the rate of complications at donor sites was studied. Complications of donor sites included delayed healing, hypertrophic scarring, partial skin graft loss, suture edge necrosis, seroma, and superficial epithelial loss, which were merged together.…”

“…The effect of the number of perforators on outcomes has been widely debated (Grover et al, 2014; Karaaltin et al, 2011; Mulvey et al, 2013; Wang et al, 2019). Many studies have shown that multiple perforators can reduce the rate of skin flap partial necrosis, fat necrosis and incidence of complications, as well as improve the success rate of free flaps (Baumann et al, 2010; Grover et al, 2014; Hembd et al, 2018; Taufique et al, 2019); however, some studies have suggested that a single large perforator is sufficient (Kruse et al, 2010; Taufique et al, 2019). Intraoperative dissection of multiple perforators can increase the duration of the operation and add additional nerve and muscle damage (Douglas et al, 2014; Kekatpure et al, 2011; Tang et al, 2013; Wang et al, 2019).…”

Simultaneous Paramedian Pedicle Forehead and Free Medial Sural Artery Perforator Flap Reconstruction of a Composite Nasal Defect: A Case Report

“…This can cover an area of approximately 120 cm 2 . 16,17 However, the reported maximum size is 14 Â 14 cm. 18 When the width is less than 6 cm, the wound can be closed without the need for a skin graft.…”