A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation. One of the main issues encountered when performing an msap flap is venous congestion 2, a commonly described complication in other perforator based flaps 3. However, the outcome of these methods are always unsatisfactory, frequently compromising knee joint function and appearance. Distally based perforator sural flaps for foot and ankle. Over the last decade, the medial sural artery perforator msap flap has emerged as a possible alternative with lower donor site morbidity. No major flaprelated complications occurred except 1. Elevation of the flap will not affect the vascularity of the gastrocnemius muscle. The radial forearm flap is frequently considered the first choice for tongue reconstruction, but the disadvantages of donor site morbidity are well known. Introduction the medial sural artery perforator msap flap was first described in 2001. Eight of ten legs had two or more sizable perforators. Medial sural artery perforator flap for tongue and floor. The medial sural artery muscle perforator flap would be called the msap flap using the canadian terminology 9, or the ms medial gastrocnemius muscle perforator flap if one prefers to include both the source vessel and the muscle intermediary as part of the nomenclature 10. A perforator within this region is routinely present. Treatment of skin defect around the knee using medial.
The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. Skin is removed from the back of the lower leg and then moved to fill a hole which has been left from having a cancer removed. The true medial sural perforator free flap was first introduced by cavadas et al. All patients in whom msap flap free and pedicled was performed for reconstruction are. Medial sural artery perforator flap plastic surgery key. In 1988 masquelet et al8 introduced the lateral supramalleolar flap that perfused by the anterior perforator of the peroneal artery located at. We evaluated the versatility of this flap and provide further evidence on its use for covering small. A medial sural artery perforator free flap is also known as an msap flap. Medial sural artery perforator flap msap harvesting for head and neck microsurgical reconstruction. The medial sural artery perforator msap flap captures the cutaneous territory of the medial calf, and can potentially be advantageous as a thin free flap, even in the most obese individual, for. 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.
Having constant anatomy, long pedicle, and pliable soft tissue, the flap was shown to be a good alternative option for soft tissue reconstruction. The splitting of an elliptical flap into two triangles allows both reconstruction of circular defects and primary closure of the donor site. Pdf versatility of the medial sural artery perforator. The medial sural artery perforator flap is a relatively thin cutaneous flap which is designed over the medial head of the gastrocnemius muscle. The free medial sural artery perforator flap wiley online library. The medial sural artery perforator flap has at least one or two perforators with an average size of 8. The preferred perforator was the one figure 1 the medial sural artery divides into two.
Preoperatively, the medial calf was examined with the handheld doppler. Original article the proximally based lateral superficial. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein. Because of its potentially long vascular pedicle based on the medial sural vessels, reach as an island flap not requiring a microanastomosis for knee coverage is another asset 4. The medial sural artery perforator msap flap shows advantages for reconstruction in the foot and ankle, where bulk is a liability. This perforator flap is typically based on the proximal perforator of the medial sural artery supplying the gastrocnemius muscle.
Depending on defect location, the msap flap may be utilized as a propeller or vy advancement flap 1. The proximally based sural artery flap from the posterior calf region is used for reconstruction of such defects bec. Reconstruction of composite defects of the posterior thigh and knee is challenging. The medial sural artery perforator flap was originally heralded as a promising thin free flap donor site, most ideal for the ipsilateral distal lower extremity. Jan 18, 2019 the medial sural artery perforator flap was originally heralded as a promising thin free flap donor site, most ideal for the ipsilateral distal lower extremity. This descriptive case series was conducted at jinnah burn and reconstructive surgery center, lahore during october 2016 to august 2017. Microsurgery medial sural artery perforator msap flap harvest duration. The medial sural artery perforator msap flap is based on musculocutaneous perforators of the medial gastrocnemius muscle. Limited arc of rotation and reach of the flap as well as unsightly muscle bulk are major disadvantages and were the impetus to look for a local alternative. A pragmatic evaluation of the role of the medial sural. The medial sural artery originated from the popliteal artery in 70% and had its external diameter at a mean of 3 0.
Tong, a clinical professor and chairman of department of otorhinolaryngology, head and neck surgery, as well as the director of the institute of human communicative research at the chinese university of hong kong cuhk, is specialized in. The medial sural artery perforator island flap as a simpler. Length of the pedicle of the medial sural artery perforator. The anatomical basis of the medial sural artery perforator. The medial sural artery perforator flap and its application. Medial sural artery perforator msap free flap surgery this leaflet has been written to help your understanding of medial sural artery perforator free flap surgery. It is a useful alternative to radial forearm flap providing hairless tissue and less donorsite morbidity. The number of its perforators was at a mean of two perforators. Alt flap, and the medial sural perforator flap has emerged as a possible candidate to fill this gap. Whereas in over 90% of patients a major medial gas. Many studies on flap vascularization and its clinical use were subsequently published 2 3. Pdf vascular anatomy of the medial sural artery perforator. The aim of this study is to present a consecutive series of patients with a reconstruction about the knee involving the medial sural artery perforator flap msapf.
The medial sural artery gives at least one large perforator while the lateral sural artery perforators are either inconsistent in location or absent 7,25. Chenganatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Reverse sural flap for ankle and heel soft tissues. The medial sural artery originated from the popliteal artery. A new classification system of intramuscular branching patterns. Depending on defect location, the msap flap may be utilized as a propeller or vy advancement flap. We report our experience of using the medial sural artery perforator flap in the reconstruction of soft tissue defects in the hand in seven cases with 1 to 2 year followup. The medial sural artery perforator flap msapf was first performed by cavadas et al in 2001 as a modification of the classic gastrocnemius myocutaneous flap 1. A pragmatic evaluation of the role of the medial sural artery. The medial sural perforator flap was described in a very similar fashion in cadaver dissections by taylor and daniel as a potential free flap donor site as early as 1975. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein grafts are rarely needed to reach a. The medial sural artery supplies the medial gastrocnemius muscle and sends. One of the advantages of this thin fasciocutaneous flap is that it permits skin coverage with ideal contouring.
Extended use of chimeric medial sural artery perforator. A consecutive series of 17 cases of defect reconstructions about the knee using the msapf is described, with an emphasis on early postoperative complications. The aim of this study was to report our experience with this flap for reconstruction throughout the body, highlighting its potentially increasing role as a. At our institution, the alt flap is the flap of choice for. A flap was designed such that the distal perforator artery was centrally located in the flap. Department of otorhinolaryngology, head and neck surgery. The versatility of the flap hinges on the ability to harvest multiple tissue components in various combinations but from the same wound. Medial sural artery perforator msap free flap surgery. The medial sural artery perforator flap presents a new concept that involves a single musculocutaneous perforator to supply a whole skin flap. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. Vascular anatomy of the medial sural artery perforator.
Surgical anatomy of the medial sural artery perforator flap. The medial sural artery perforator msap flap shows. Hallock, md1 1division of plastic surgery, sacred heart and the lehigh valley. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns.
The territory approximates to the medial half of the upper third of the posterior calf, an area of about 8x12 cm. In the last decade, the medial sural artery perforator flap msap has emerged as one of the most popular reconstructive options for multiple body sites. The medial sural artery flap was formally described by cavadas in 2001, based on musculocutaneous perforators from the medial sural artery. Apr 02, 2016 the design of the desired flap is centered around the most distal perforator found to ensure the longest possible pedicle fig.
Medial sural artery perforator flap for repair of the hand. Chen sl, chen tm, lee ch 2005 free medial sural artery perforator flap resurfacing distal limb defects. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask. The patients were 2 men and 3 women who were 3672 years old. Medial sural artery perforator flap for head and neck reconstruction. Microsurgery medial sural artery perforator msap flap. Multidigit contracture release using medial sural artery. Over the last decade, the medial sural artery perforator msap flap has.
Hallock, md1 1division of plastic surgery, sacred heart and the lehigh valley hospitals, allentown, pennsylvania, st. Baek 2 was the first to report its clinical applications along with anatomical observations regarding medial and lateral femoral free flaps. Furthermore, chimeric msap flap, which includes a skin paddle and a separated piece of medial gastrocnemius muscle, allowed more freedom for flap insetting, especially. The patient usually will be positioned supine with the thigh abducted, lower leg externally rotated, and. Vascular anatomy of the medial sural artery perforator flap. Extended use of chimeric medial sural artery perforator flap. 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 3dimensional defect reconstruction. The surgery was facilitated by general anesthesia, tourniquet use, and the use of 2.
The medial sural perforator msap flap was first described in 2001 by cavadas et al. Zhonghua kou qiang yi xue za zhi zhonghua kouqiang yixue zazhi chin j stomatol. The medial sural artery perforator island flap as a. The possible use of these musculocutaneous perforators as the source of a perforator based free flap was investigated in cadavers. Nugent m, endersby s, kennedy m, burns a 2015 early experience with the medial sural artery perforator flap as an alternative to the radial forearm flap for reconstruction in the head and neck. A sensate lateral sural artery muscle perforator flap. The main difficulty encountered when raising the msap flap is in obtaining adequate pedicle length during intramuscular dissection. 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. Because of its potentially long vascular pedicle based on the medial sural vessels, reach as an island flap not requiring a microanastomosis for knee coverage is another asset. It can be extended anteriorly to 23rd of the distance from the. The medial sural artery perforator msap fasciocutaneous flap was first described by cavadas 2001 as a refinement of the medial gastrocnemius flap. The possible use of these musculocutaneous perforators as the source of a perforatorbased free flap was investigated in cadavers.
Its blood supply comes from at least one, preferably the dominant myocutaneous perforator, which develops from the medial sural artery. A pragmatic evaluation of the role of the medial sural artery perforator flap. May 24, 2015 oral and extremity defect reconstruction can often require a flap that is thin, and traditionally, the radial forearm free flap has been used, however, this has significant donor site morbidity. On average, there are 4 musculofasciocutaneous perforators, of 0. The medial sural artery perforator msap flap provides a thin, pliable and durable soft tissue reconstruction with adequate pedicle length and low donor morbidity. This perforator flap is typically based on the proximal perforator of the. Medial sural artery perforator flap for tongue and floor of. More recently, the medial sural artery perforator msap flap has been described for such defects, although may necessitate skin grafting of the donor. The distally based sural artery flap, which is perfused by reverse flow through the anastomosis between the superficial sural artery and the lowermost perforator of the peroneal artery, forms part of this group. The medial sural artery perforator msap flap is a fasciocutaneous flap and it was first described by cavadas et al. Apr 03, 2015 buccomandibular defect repair with free medial sural artery perforator flap.
Split median superficial sural artery perforator mssap flap. Technique and strategy in anterolateral thigh perforator flap surgery. Jun, 2016 the distally based sural artery flap, which is perfused by reverse flow through the anastomosis between the superficial sural artery and the lowermost perforator of the peroneal artery, forms part of this group. The main perforators of the medial sural artery are located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. Medial sural artery perforator free flap msap british. The medial sural artery perforator msap flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. The medial sural perforator flap was described in a very similar fashion in cadaver dissections by taylor and daniel 1 as a potential free flap donor site as early as 1975.
Theanatomicalbasisofthemedialsuralarteryperforatorflaps. The largest of the perforator had an average external. Split median superficial sural artery perforator mssap. Our modification leads to a favorable engorgement of the flap pedicle and perforators, without the need of a tourniquet and also improves the surgical field accessibility for the surgeon. We present an advantageous modification of the standard positioning. Medial sural artery perforator flap for head and neck.
Oral and extremity defect reconstruction can often require a flap that is thin, and traditionally, the radial forearm free flap has been used, however, this has significant donor site morbidity. Download as an information leaflet pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. Flap territory the medial sural artery perforator msap fasciocutaneous flap was first described by cavadas 2001 as a refinement of the medial gastrocnemius flap. Lukes hospital, bethlehem, pennsylvania j reconstr microsurg 2014. The medial sural artery perforator msap flap is a fasciocutaneous flap and it. This perforator flap is typically based on the proximal perforator of the medial. Pdf versatility of the medial sural artery perforator flap. We used the pedicled medial sural artery perforator flap for coverage of the skin defect around the knee. Pdf reverseflow medial sural artery perforator flap. The medial sural artery perforator msap flap is a versatile fasciocutaneous flap. Treatment of skin defect around the knee using medial sural. 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. This is the first description of a combined pedicled median superficial sural artery perforatormedial sural artery perforator msap flap for posterior thigh reconstruction. Use of the pedicled medial sural artery perforator msap fasciocutaneous flap has been widely reported in the literature for ipsilateral lower limb reconstruction.
942 79 1397 694 1048 1258 1454 1519 1152 1476 1505 777 1152 59 1163 1422 698 621 146 684 1484 442 1349 1472 630 803 215 1447 983 879 990 397 1052 711 649 1351