Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Medial sural artery perforator flap – Single centre experience in extremity and head and neck reconstruction  (1374)

Jan Janzekovic 1 , Jonathan D Wiper 1
  1. Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia

Purpose. The medial sural artery perforator (MSAP) free flap is gaining traction as an additional option in reconstructive surgery due to its low donor site morbidity, reliable pedicle and thin, pliable characteristics. These properties make it an ideal option in a variety of head and neck, upper and lower extremity defects. To date no clinical data has been reported in the Australian population. We analyse a single centre’s experience with the MSAP free flap with respect to versatility, outcomes and donor site morbidity.

Methodology. Retrospective analysis of consecutive cases between 2018 and 2020 using the MSAP flap. Data was collected from hospital database and operation reports, with photographic evidence used to support findings. Patient demographics, co-morbidities, indication for reconstruction, defect location, recipient vessel, Ischaemic time, length of stay, length of follow up, complications and outcome were recorded.

Results. Nine patients were included in this study (n=9). 8 males and 1 female, with an average age of 53.3 years (range 35-68). Three head and neck, five lower limb and one upper limb defect was reconstructed. All donor sites were closed directly, one patient developed donor site haematoma requiring evacuation. Overall 8 flaps were successful with one flap loss. Three patients required return to theatre; one for haematoma and two for venous thrombosis requiring revision. Average length of hospital stay was 13.9 days (range 9-21 days), average follow up 3 months (range 1-6 months).

Conclusion. The medial sural artery is a viable option across head and neck, upper and lower extremity reconstruction when thin tissue is required. It has the additional benefit of minimal donor site morbidity compared to the radial artery free flap given that it can be closed directly in most cases.

  1. Saint-Cyr, M., M.V. Schaverien, and R.J. Rohrich, Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg, 2009. 123(4): p. 132e-145e.
  2. Cavadas, P.C., et al., The medial sural artery perforator free flap. Plast Reconstr Surg, 2001. 108(6): p. 1609-15; discussion 1616-7.
  3. Daar, D.A., et al., Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis. Plast Reconstr Surg, 2019. 143(2): p. 393e-403e.
  4. Kao, H.K., et al., Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions. Plast Reconstr Surg, 2009. 124(4): p. 1125-32.
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