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Sampieri G, Tran J, Feng AL, Agur A, Davies J. Characterization of the MSAP Flap in Head and Neck Surgical Oncology: A 3D Cadaveric Study. Laryngoscope 2024; 134:4298-4303. [PMID: 38804643 DOI: 10.1002/lary.31532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/06/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The medial sural artery (MSA) perforator flap is a versatile free flap. However, the cutaneous perforators are not well characterized. The objectives of this pilot anatomical study were to: (1) visualize in three-dimensions, as in-situ, the origin, course, and distribution of the cutaneous perforators, (2) characterize the number and frequency of the perforators, and (3) quantify mean pedicle length. METHODS Thirteen cadaveric specimens were dissected, digitized, and modeled in 3D. Three-dimensional models and dissection photographs were used to determine the origin, course, number, distribution, and pedicle length of MSA perforators. RESULTS The most common pattern consisted of three perforators (39% of specimens). The maximum number of perforators identified was four (23%). The majority of specimens (92%) had a cutaneous perforator originating from the lateral branch of the MSA and coursed most frequently in the second (43%) and third (37%) quartiles of the length of the tibia. Mean pedicle length was 19.1 ± 6.9 cm. Perforators originating from the medial branch of the MSA were significantly (p < 0.05) shorter than those from the lateral branch and were found to course only in the first quartile. CONCLUSION The 3D models constructed in this study provide a comprehensive overview of the location and course of the perforators, enabling measurement of parameters in 3D-space. Anatomical characterization of the MSA perforator flap using 3D analysis can assist reconstructive surgeons in understanding the relevant anatomy and optimizing the surgical technique for flap harvest. LEVEL OF EVIDENCE N/A Laryngoscope, 134:4298-4303, 2024.
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Affiliation(s)
- Gianluca Sampieri
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John Tran
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Anne Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Falkner F, Thomas B, Vollbach FH, Didzun O, Harhaus L, Gayzakan E, Kneser U, Bigdeli AK. [Free medial sural artery perforator flap for reconstruction of hand defects]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:292-304. [PMID: 39237754 DOI: 10.1007/s00064-024-00863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 09/04/2023] [Accepted: 10/23/2023] [Indexed: 09/07/2024]
Abstract
OBJECTIVE Defect reconstruction of the hand by means of the free medial sural artery perforator (MSAP) flap. INDICATIONS Reconstruction of full-thickness defects on the hand with a thin non-bulky flap in cases of exposure of functional structures or in combination with simultaneous osteosynthetic procedures. CONTRAINDICATIONS Prior surgery at the donor site or progressive peripheral artery occlusive disease. Defect size that exceeds the maximum width of the free MSAP flap for primary closure of the donor site. Lack of patient consent or compliance. SURGICAL TECHNIQUE Suitable perforators are identified through a medial incision on the calf. The vascular pedicle is then completely followed subfascially along the gastrocnemius muscle until its source vessel the medial sural artery is reached. Subsequently, the flap design is adapted to the perforator anatomy and the flap is completely elevated. Indocyanine green fluorescence angiography can be used to identify the size of the reliable angiosome. POSTOPERATIVE MANAGEMENT Close monitoring of the flap is required for the first 48 hours after surgery. Anticoagulation with low-molecular weight heparin should be administered for thrombosis prophylaxis. The hand can be mobilized on the first day after surgery. RESULTS Between May 2017 and March 2022 a total of 16 free MSAP flaps were carried out for hand defect reconstruction. All donor sites were primarily closed. The reconstruction was successful in all cases. In one patient venous thrombosis occurred postoperatively, which was successfully revised. In two flaps, surgical hematoma evacuation was necessary within 24 hours after surgery. Complications or wound healing disorders at the donor site were not observed.
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Affiliation(s)
- Florian Falkner
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Benjamin Thomas
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Felix H Vollbach
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Oliver Didzun
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Leila Harhaus
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Emre Gayzakan
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Ulrich Kneser
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland
| | - Amir K Bigdeli
- BG Klinik Ludwigshafen, Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie - Schwerbrandverletztenzentrum, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland.
- Hand‑, Plastische und Rekonstruktive Chirurgie, Ruprecht-Karls-Universität Heidelberg, 69120, Heidelberg, Deutschland.
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Largo RD, Chang EI. Discussion: Radial and Ulnar Forearm Free Flaps: A Critical Comparison of Donor-Site Morbidity and Its Impact on Quality of Life. Plast Reconstr Surg 2024; 154:662-663. [PMID: 39196868 DOI: 10.1097/prs.0000000000011167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Affiliation(s)
- Rene D Largo
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
| | - Edward I Chang
- From the Department of Plastic Surgery, University of Texas MD Anderson Cancer Center
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Lee ZH, Canzi A, Yu J, Chang EI. Expanding the Armamentarium of Donor Sites in Microvascular Head and Neck Reconstruction. J Clin Med 2024; 13:1311. [PMID: 38592147 PMCID: PMC10932027 DOI: 10.3390/jcm13051311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
The field of microsurgical head and neck reconstruction has witnessed tremendous advancements in recent years. While the historic goals of reconstruction were simply to maximize flap survival, optimizing both aesthetic and functional outcomes has now become the priority. With an increased understanding of perforator anatomy, improved technology in instruments and microscopes, and high flap success rates, the reconstructive microsurgeon can push the envelope in harvesting and designing the ideal flap to aid patients following tumor extirpation. Furthermore, with improvements in cancer treatment leading to improved patient survival and prognosis, it becomes increasingly important to have a broader repertoire of donor sites. The present review aims to provide a review of newly emerging soft tissue flap options in head and neck reconstruction. While certainly a number of bony flap options also exist, the present review will focus on soft tissue flaps that can be harvested reliably from a variety of alternate donor sites. From the upper extremity, the ulnar forearm as well as the lateral arm, and from the lower extremity, the profunda artery perforator, medial sural artery perforator, and superficial circumflex iliac perforator flaps will be discussed, and we will provide details to aid reconstructive microsurgeons in incorporating these alternative flaps into their armamentarium.
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Affiliation(s)
| | | | | | - Edward I. Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
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Hallock GG. The Medial Sural Artery Perforator Flap: A Historical Trek from Ignominious to “Workhorse”. Arch Plast Surg 2022; 49:240-252. [PMID: 35832674 PMCID: PMC9045491 DOI: 10.1055/s-0042-1744425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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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Affiliation(s)
- Geoffrey G. Hallock
- Division of Plastic Surgery, St. Luke's Hospital, Sacred Heart Division, Allentown, Pennsylvania
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Current Concepts for Reconstruction of Oral Tissues Following Ablative Surgery: A Comprehensive Approach. J Maxillofac Oral Surg 2022; 21:358-368. [DOI: 10.1007/s12663-022-01704-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
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Functional Outcomes of the Medial Sural Artery Perforator Flap in Oral Cavity Reconstruction. Ann Plast Surg 2021; 85:256-259. [PMID: 32205498 DOI: 10.1097/sap.0000000000002352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The medial sural artery perforator (MSAP) flap is an ideal option for reconstruction of oral cavity defects owing to its thin and pliable nature and favorable donor site. Our study presents an assessment of functional outcomes including speech and swallowing in patients with oral cavity tumors reconstructed with MSAP flaps. METHODS Patients undergoing MSAP reconstruction for oral cavity tumors between January 2014 and January 2018 were identified from our prospective head and neck cancer database. Functional outcomes were assessed in conjunction with the Speech and Language Team with a minimum follow-up of 6 months. Function (speech and swallowing) was recorded as a performance status scale set up by the assessing health care professional. RESULTS A total of 38 patients underwent reconstruction with the MSAP flap over the study period. The patient cohort included 10 female patients and 28 male patients. The age range was from 30 to 78 years, with a mean age of 56.8 years. Complications included 1 flap loss and 1 donor site wound dehiscence.Most patients (84.2%) had intelligible speech at 6-month follow-up and further improvement at 1 year (92.1%). All patients resumed feeding on postoperative day 4, and only 7.8% (n = 3) of the patients required assistance with feeding at 1-year follow-up. CONCLUSIONS The MSAP flap provides adequate small-volume replacement for oral cavity reconstructions. Our results indicate that most patients achieve a full diet with no restrictions by 1 year after reconstruction. Most of our patients demonstrated excellent speech with little or no need for repetition in conversation. Over the past few years, this has become the flap of choice for oral cavity reconstruction in our unit.
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Fang J, Chen B, Wu Y, Tang Z, Ren F, Zhang W. [Research progress of clinical application of medial sural artery perforator flap]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:508-513. [PMID: 33855838 DOI: 10.7507/1002-1892.202011032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of the clinical application of the medial sural artery perforator flap (MSAPF). Methods The relevant domestic and abroad literature on the clinical application of MSAPF was extensively consulted, and the research progress were summarized and analyzed in aspect of its definition, anatomical characteristics, clinical application, surgical resection and improvement, and advantages and disadvantages of flaps, etc. Results MSAPF has the advantages of relatively constant anatomical position, thin flap texture, long vascular pedicle, large vessel diameter, no sacrifice of main blood vessels, concealed donor site, no hair, and fewer complications; it can carry nerves, tendons, and muscles to construct chimeric flaps to repair three-dimensional wounds; and can also repair wounds with high aesthetic and functional requirements such as hand, foot and ankle, head and neck, etc. Conclusion The MSAPF is a versatile, various forms, functional diversification, and three-dimensional flap donor site with various application forms and ideal repair effectiveness.
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Affiliation(s)
- Jie Fang
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Buguo Chen
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Yao Wu
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Zhaolin Tang
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Fei Ren
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China
| | - Wenlong Zhang
- Department of Hand and Foot Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China
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Edmondson SJ, Townley WA, Orfaniotis G. Elevation of Medial Sural Artery Perforator free flap in a chronically ischaemic donor leg: findings and outcome in a case of salvage laryngopharyngectomy. Microsurgery 2020; 40:827-828. [PMID: 32744778 DOI: 10.1002/micr.30630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/05/2020] [Accepted: 06/29/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sarah-Jayne Edmondson
- Department of Head and Neck Reconstructive Surgery, Guys & St Thomas NHS Foundation Trust, Guys Hospital, London, UK
| | - William A Townley
- Department of Head and Neck Reconstructive Surgery, Guys & St Thomas NHS Foundation Trust, Guys Hospital, London, UK
| | - Georgios Orfaniotis
- Department of Head and Neck Reconstructive Surgery, Guys & St Thomas NHS Foundation Trust, Guys Hospital, London, UK
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Extended Use of Chimeric Medial Sural Artery Perforator Flap for 3-Dimensional Defect Reconstruction. Ann Plast Surg 2020; 82:S86-S94. [PMID: 30422844 DOI: 10.1097/sap.0000000000001697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The medial sural artery perforator (MSAP) flap has become increasingly popular because it is thin and pliable for small to moderate defect soft tissue reconstruction. Furthermore, chimeric MSAP flap, which includes a skin paddle and a separated piece of medial gastrocnemius muscle, allowed more freedom for flap insetting, especially in 3-dimensional defect reconstruction. Here we describe our experience regarding this clinical application. PATIENTS AND METHODS From 2007 to 2016, 14 male patients (average age, 46.9 ± 14.4 years) who received either a free or pedicled chimeric MSAP flap were included. Of these 14 patients, 7 received this flap for reconstruction in the head and neck, 2 in the upper extremities, and 5 in the lower extremities. Demographic data were collected and analyzed, and a literature review was performed. RESULTS Ten patients received free chimeric MSAP flap, and 4 received the pedicled type. Thirteen of the 14 flaps (92.6%) survived, and 1 failed 2 days later owing to venous insufficiency. Venous congestion-related partial loss occurred in another case. CONCLUSIONS The chimeric MSAP flap is a good alternative for deep space obliteration or reconstruction of adjacent but separate defects in both free and pedicled flap design. Donor site morbidity is limited. However, the perforator needs to be mobilized carefully to prevent postoperative venous compromise.
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Al-Himdani S, Din A, Wright TC, Wheble G, Chapman TWL, Khan U. The medial sural artery perforator (MSAP) flap: A versatile flap for lower extremity reconstruction. Injury 2020; 51:1077-1085. [PMID: 32192717 DOI: 10.1016/j.injury.2020.02.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The medial sural artery perforator (MSAP) flap provides a thin, pliable and durable soft tissue reconstruction with adequate pedicle length and low donor morbidity. It is an ideal choice for small-to-moderate defects of the lower extremity, although it does have limitations. We report our experience of the flap in a three-pronged anatomical, clinical and patient reported outcome-based study. METHODS Cadaveric fresh frozen lower limbs (n = 10) were used for anatomical dissections to assess pertinent and clinically relevant findings. Data relating to MSAP flaps was collected from a prospectively maintained database over a 2-year period. Both clinical data and modified Enneking scores were analysed. RESULTS Anatomical study: A mean of 2.1 ± 0.99 perforators arose from the medial sural artery, located 11.9 cm ± 2.07 along the line between the popliteal fossa and medial malleolus. The largest perforator was located 13.58 cm ± 2.01 from the popliteal artery. The distance from the dominant perforator to the first branching point within the gastrocnemius was 7.39 ± 1.50 (range 5-9.2 cm). The short saphenous vein was located on average 3.08 cm ± 0.77 from the dominant perforator. Clinical study: Twenty free and nine pedicled MSAPs were included (n = 29). Open lower limb fractures (n = 18, 62%) and infection (n = 10, 35%) were the most common aetiologies. Defects sites included: foot-and-ankle (n = 12, 55%), knee (n = 9, 31%) and anterior leg (n = 4, 14%). Four patients (14%) required SSG to for donor site coverage. Venous congestion was responsible for partial flap necrosis in 6.9%(n = 2) of patients. All wounds were healed at discharge. At 14 months, the mean Enneking score was 72.5%. All patients were ambulant, 96% returned to work and 87% were using pre-operative footwear. CONCLUSIONS The MSAP provides robust foot-and-ankle reconstruction, whilst permitting glide when over the knee. Patient satisfaction and functional outcomes are excellent with careful patient selection. Care should be taken to avoid compression or kinking of the large, thin walled veins as the most commonly observed complication was venous congestion. We advocate MSAP as a first choice flap for small-to-moderate foot, ankle or knee defects.
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Affiliation(s)
- Sarah Al-Himdani
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom
| | - Asmat Din
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom
| | - Thomas C Wright
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom
| | - George Wheble
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom
| | - Thomas W L Chapman
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom
| | - Umraz Khan
- Southmead Hospital, North Bristol NHS Trust Westbury-on-Trym, Bristol, BS10 5NB, United Kingdom.
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A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2267. [PMID: 31942327 PMCID: PMC6952141 DOI: 10.1097/gox.0000000000002267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population.
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Wolff KD, Rau A, Kolk A. Perforator flaps from the lower leg for intraoral reconstruction: Experience of 131 flaps. J Craniomaxillofac Surg 2018; 46:338-345. [DOI: 10.1016/j.jcms.2017.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022] Open
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Struk S, Schaff JB, Qassemyar Q. [The sural medial perforator flap: Anatomical bases, surgical technique and indications in head and neck reconstruction]. ANN CHIR PLAST ESTH 2017; 63:117-125. [PMID: 29203066 DOI: 10.1016/j.anplas.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery. MATERIAL AND METHODS We harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap. RESULTS A total of 23 perforators with a diameter superior than 1mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3cm±2cm from the popliteal fossa and at 3.6cm±1cm from the median line of the calf. The mean pedicle length was 12.1cm±2.5cm. At its origin, the source artery diameter was 1.8mm±0.25mm and source veins diameters were 2.45mm±0.9mm in average. There was no complication in our clinical application. DISCUSSION This study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results.
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Affiliation(s)
- S Struk
- Département de chirurgie plastique et reconstructrice, Gustave-Roussy, Cancer Campus Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - J-B Schaff
- Département de chirurgie plastique et reconstructrice, Gustave-Roussy, Cancer Campus Grand Paris, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Q Qassemyar
- Service chirurgie plastique, reconstructrice et esthétique, hôpital Tenon, université Pierre-et-Marie-Curie Paris VI, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
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