The patients were 2 men and 3 women who were 3672 years old. 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. The medial sural artery perforator msap flap is a versatile fasciocutaneous flap. Technique and strategy in anterolateral thigh perforator flap surgery. Flap territory the medial sural artery perforator msap fasciocutaneous flap was first described by cavadas 2001 as a refinement of the medial gastrocnemius flap. The medial sural artery perforator msap fasciocutaneous flap was first described by cavadas 2001 as a refinement of the medial gastrocnemius flap. 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. 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. This perforator flap is typically based on the proximal perforator of the. The territory approximates to the medial half of the upper third of the posterior calf, an area of about 8x12 cm.
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. 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. 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. Baek 2 was the first to report its clinical applications along with anatomical observations regarding medial and lateral femoral free flaps. Use of the pedicled medial sural artery perforator msap fasciocutaneous flap has been widely reported in the literature for ipsilateral lower limb reconstruction. 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. Medial sural artery perforator flap for head and neck reconstruction.
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. Pdf versatility of the medial sural artery perforator. A sensate lateral sural artery muscle perforator flap. A consecutive series of 17 cases of defect reconstructions about the knee using the msapf is described, with an emphasis on early postoperative complications. 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. Many studies on flap vascularization and its clinical use were subsequently published 2 3. Vascular anatomy of the medial sural artery perforator flap. Introduction the medial sural artery perforator msap flap was first described in 2001. Department of otorhinolaryngology, head and neck surgery. Extended use of chimeric medial sural artery perforator. Eight of ten legs had two or more sizable perforators. The medial sural artery perforator island flap as a. It can be extended anteriorly to 23rd of the distance from the.
At our institution, the alt flap is the flap of choice for. Medial sural artery perforator flap for tongue and floor of. A flap was designed such that the distal perforator artery was centrally located in the flap. The medial sural artery perforator island flap as a simpler. Split median superficial sural artery perforator mssap. Apr 03, 2015 buccomandibular defect repair with free medial sural artery perforator flap. The medial sural artery perforator msap flap shows advantages for reconstruction in the foot and ankle, where bulk is a liability. 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. Medial sural artery perforator free flap msap british. Surgical anatomy of the medial sural artery perforator flap. Microsurgery medial sural artery perforator msap 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. The medial sural artery perforator msap flap is a fasciocutaneous flap and it was first described by cavadas et al. No major flaprelated complications occurred except 1.
The medial sural artery perforator flap is a relatively thin cutaneous flap which is designed over the medial head of the gastrocnemius muscle. Reconstruction of composite defects of the posterior thigh and knee is challenging. Over the last decade, the medial sural artery perforator msap flap has emerged as a possible alternative with lower donor site morbidity. 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. 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. The medial sural artery perforator flap presents a new concept that involves a single musculocutaneous perforator to supply a whole skin flap. 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. 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. Medial sural artery perforator flap plastic surgery key. The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. This perforator flap is typically based on the proximal perforator of the medial sural artery supplying the gastrocnemius muscle. A perforator within this region is routinely present.
Distally based perforator sural flaps for foot and ankle. The main difficulty encountered when raising the msap flap is in obtaining adequate pedicle length during intramuscular dissection. The free medial sural artery perforator flap wiley online library. 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. This is the first description of a combined pedicled median superficial sural artery perforatormedial sural artery perforator msap flap for posterior thigh reconstruction. Pdf reverseflow medial sural artery perforator flap. The medial sural artery perforator msap flap provides a thin, pliable and durable soft tissue reconstruction with adequate pedicle length and low donor morbidity. Legitimate use as a solution for the ipsilateral distal lower extremity defect geoffrey g. A new classification system of intramuscular branching patterns. 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 originated from the popliteal artery. Length of the pedicle of the medial sural artery perforator. The medial sural artery perforator flap and its application. 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 flap. Treatment of skin defect around the knee using medial sural. We present an advantageous modification of the standard positioning. Lukes hospital, bethlehem, pennsylvania j reconstr microsurg 2014.
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. The patient usually will be positioned supine with the thigh abducted, lower leg externally rotated, and. The possible use of these musculocutaneous perforators as the source of a perforatorbased free flap was investigated in cadavers. A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation. 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. The medial sural artery perforator msap flap is a fasciocutaneous flap and it. 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. Its blood supply comes from at least one, preferably the dominant myocutaneous perforator, which develops from the medial sural artery. This descriptive case series was conducted at jinnah burn and reconstructive surgery center, lahore during october 2016 to august 2017. The possible use of these musculocutaneous perforators as the source of a perforator based free flap was investigated in cadavers. One of the advantages of this thin fasciocutaneous flap is that it permits skin coverage with ideal contouring. Hallock, md1 1division of plastic surgery, sacred heart and the lehigh valley hospitals, allentown, pennsylvania, st. Medial sural artery perforator flap for head and neck.
Treatment of skin defect around the knee using medial. 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. Depending on defect location, the msap flap may be utilized as a propeller or vy advancement flap 1. The anatomical basis of the medial sural artery perforator. In 1988 masquelet et al8 introduced the lateral supramalleolar flap that perfused by the anterior perforator of the peroneal artery located at. 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. Having constant anatomy, long pedicle, and pliable soft tissue, the flap was shown to be a good alternative option for soft tissue reconstruction. Split median superficial sural artery perforator mssap flap. Depending on defect location, the msap flap may be utilized as a propeller or vy advancement flap.
The largest of the perforator had an average external. We evaluated the versatility of this flap and provide further evidence on its use for covering small. On average, there are 4 musculofasciocutaneous perforators, of 0. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns.
A pragmatic evaluation of the role of the 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. Preoperatively, the medial calf was examined with the handheld doppler. 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.
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. The radial forearm flap is frequently considered the first choice for tongue reconstruction, but the disadvantages of donor site morbidity are well known. 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. Elevation of the flap will not affect the vascularity of the gastrocnemius muscle. Whereas in over 90% of patients a major medial gas. Alt flap, and the medial sural perforator flap has emerged as a possible candidate to fill this gap. The medial sural artery supplies the medial gastrocnemius muscle and sends. Theanatomicalbasisofthemedialsuralarteryperforatorflaps.
Zhonghua kou qiang yi xue za zhi zhonghua kouqiang yixue zazhi chin j stomatol. Microsurgery medial sural artery perforator msap flap harvest duration. Pdf vascular anatomy of the medial sural artery perforator. The preferred perforator was the one figure 1 the medial sural artery divides into two. A pragmatic evaluation of the role of the medial sural.
Chen sl, chen tm, lee ch 2005 free medial sural artery perforator flap resurfacing distal limb defects. It is a useful alternative to radial forearm flap providing hairless tissue and less donorsite morbidity. Medial sural artery perforator flap for repair of the hand. The medial sural artery perforator msap flap is based on musculocutaneous perforators of the medial gastrocnemius muscle. 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. 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. All patients in whom msap flap free and pedicled was performed for reconstruction are. The medial sural perforator msap flap was first described in 2001 by cavadas et al. 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. 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. 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 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 perforator flap msapf was first performed by cavadas et al in 2001 as a modification of the classic gastrocnemius myocutaneous flap 1. A medial sural artery perforator free flap is also known as an msap flap. The versatility of the flap hinges on the ability to harvest multiple tissue components in various combinations but from the same wound. 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.
The medial sural artery perforator msap flap shows. Over the last decade, the medial sural artery perforator msap flap has. The number of its perforators was at a mean of two perforators. Medial sural artery perforator msap free flap surgery. The medial sural artery perforator flap has at least one or two perforators with an average size of 8. A pragmatic evaluation of the role of the medial sural artery. Multidigit contracture release using 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 tongue and floor. However, the outcome of these methods are always unsatisfactory, frequently compromising knee joint function and appearance. Chenganatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. The surgery was facilitated by general anesthesia, tourniquet use, and the use of 2. This perforator flap is typically based on the proximal perforator of the medial.
The proximally based sural artery flap from the posterior calf region is used for reconstruction of such defects bec. More recently, the medial sural artery perforator msap flap has been described for such defects, although may necessitate skin grafting of the donor. The true medial sural perforator free flap was first introduced by cavadas et al. 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. Extended use of chimeric medial sural artery perforator flap.
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. The medial sural artery flap was formally described by cavadas in 2001, based on musculocutaneous perforators from the medial sural artery. Reverse sural flap for ankle and heel soft tissues. Hallock, md1 1division of plastic surgery, sacred heart and the lehigh valley. The medial sural artery originated from the popliteal artery in 70% and had its external diameter at a mean of 3 0. Medial sural artery perforator flap msap harvesting for head and neck microsurgical reconstruction.
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