MEDIAL SURAL ARTERY PERFORATOR FLAP: A VERSATILE OPTION FOR SOFT TISSUE RECONSTRUCTION OF HEAD AND NECK AND LIMBS
AbstractBackground: To assess the outcome of Medial Sural Artery Perforator Flap (MSAP Flap) as an option for the soft tissue reconstruction of head and neck and limbs. Methods: This descriptive case series was conducted at Jinnah Burn and Reconstructive Surgery Center, Lahore during October 2016 to August 2017. All patients in whom MSAP flap (free and pedicled) was performed for reconstruction are included. Patients were followed at one week and one month after the discharge and data was entered into the proformas. Results: In total, 18 patients were operated with this flap. Free and pedicled MSAP flap were performed for reconstruction of soft tissue defects in the head and neck and the lower limb. The maximum dimensions of the flap were 14 cm length and 10 cm width. The maximum pedicle length was 16cm. All flaps survived and showed good outcome. There was necrosis of the distal margin of a pedicled flap, but no case of venous congestion and flap failure was observed. The flap donor site was closed primarily in 7 patients while split skin graft was used in the rest of the patients. Conclusion: The MSAP flap provides a thin skin paddle and has minimal donor site morbidity as compared to the other options. It is a good addition to the armamentarium of perforator flaps which are thin and pliable, can be harvested by two team approaches, under the tourniquet and has a hidden donor site.Keywords: Medial Sural artery; Perforator flap; Soft tissue coverage; Reconstruction
Toyserkani NM, Sorensen JA. Medial sural artery perforator flap: a challenging free flap. Eur J Plast Surg 2015;38(5):391–6.
Adkinson JM, Chung KC. Flap reconstruction of elbow and forearm: A case-based approach. Hand Clin 2014;30(2):153–63.
Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984;37(2):149–59.
Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg 2014;72(2):246–52.
Loeffelbein DJ, Al-Benna S, Steinsträßer L, Satanovskij RM, Rohleder NH, Mücke T, et al. Reduction of donor site morbidity of free radial forearm flaps: what level of evidence is available? Eplasty 2012;12:e9.
Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, Navarro-Monzonís A, Soler-Nomdedeu S, Martínez-Soriano F. The medial sural artery perforator free flap. Plast Reconstr Surg 2001;108(6):1609–15, discussion 1616–7.
Choi JW, Nam SY, Choi SH, Roh JL, Kim SY, Hong JP. Applications of medial sural perforator free flap for head and neck reconstructions. J Reconstr Microsurg 2013;29(7):437–42.
Kao HK, Chang KP, Chen YA, Wei FC, Cheng MH. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg 2010;125(4):1135–45.
Özkan HS, İrkören S, Aydın OE, Eryılmaz A, Karaca H. Medial sural artery perforator flap in head and neck reconstruction. Eur Arch Otorhinolaryngol 2016;273(12):4431–6.