An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius

Introduction: Since first described by Cadavas, A free medial sural artery perforator flap (MSAP) is getting popularity day by day. Specially, where the micro surgeons are desired to have thin, pliable flap with long pedicle and less donor site morbidities. For its above-mentioned characteristics and good outcome, it is now considered as one of the workhorse flaps for head and neck reconstruction. Aims and Objectives: The aim was to find out the feasibilities and versatilities of this flap as workhorse in head and neck reconstruction. As well as taking into consideration of its low donor site morbidities. Methods: A literature search has been performed in July 2020 in various data base including Pub Med, Trip database, Medline and Google Scholler to find out the outcome of head and neck reconstruction with free MSAP Flap. Data then were tabulated and analysed using Microsoft Excel datasheet. Results: The results were promising. Overall, flap survival rate was 95%. Mean flap dimension was 9.3 cm x5.5 cm. Average pedicle length was 10.5 cm. Mean flap thickness was 6mm. Overall complication rate was 16% including 6% wound related and 2% donor site complication. Most of the cases donor site have closed directly (87%). Conclusion: Free MSAP Flap is an ideal workhorse flap for head and neck reconstruction. However, as most of the literatures were case series or personal experiences of surgeons, a multicentre trial with large sample can give us more information.

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Synchronous Bilateral Local Medial Sural Artery Perforator Flaps for “Hooker Knees”

10.31487/j.jscr.2020.02.07 ◽

2020 ◽

pp. 1-3

Author(s):

Geoffrey Hallock ◽

Geoffrey Hallock

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Pressure Sore ◽

Pressure Sores ◽

Ambulatory Patient ◽

Perforator Flaps ◽

Basic Principles ◽

Tissue Ischemia ◽

Sural Artery ◽

Artery Perforator

Pressure sores restricted to the knee region in an ambulatory patient are extremely unusual. However, this can be an occupational hazard for the prostitute who is not given the courtesy of adequate breaks to prevent simultaneous bilateral knee tissue ischemia. The existence of this condition to date has been poorly discussed in the reconstructive literature. Yet treatment varies little from the basic principles for pressure sore management. Once that is completed, the medial sural artery perforator flap donor site usually remains uninvolved by any etiological mechanisms and provides a local flap with a long pedicle that potentially can permit the necessary synchronous coverage of the bilateral “hooker knee.”

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Comparison of the Medial Sural Artery Perforator Flap with the Radial Forearm Flap for Head and Neck Reconstructions

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e3181b457cf ◽

2009 ◽

Vol 124 (4) ◽

pp. 1125-1132 ◽

Cited By ~ 57

Author(s):

Huang-Kai Kao ◽

Kai-Ping Chang ◽

Fu-Chan Wei ◽

Ming-Huei Cheng

Keyword(s):

Head And Neck ◽

Perforator Flap ◽

Radial Forearm Flap ◽

Forearm Flap ◽

Radial Forearm ◽

Sural Artery ◽

Artery Perforator

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Medial Sural Artery Perforator Flap

Annals of Plastic Surgery ◽

10.1097/sap.0b013e31821190e6 ◽

2012 ◽

Vol 68 (1) ◽

pp. 105-110 ◽

Cited By ~ 29

Author(s):

Xue-Tao Xie ◽

Yi-Min Chai

Keyword(s):

Perforator Flap ◽

Sural Artery ◽

Artery Perforator

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Comprehensive Analysis of Donor-Site Morbidity following Free Thoracodorsal Artery Perforator Flap Harvest

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002396 ◽

2016 ◽

Vol 138 (4) ◽

pp. 899-909 ◽

Cited By ~ 7

Author(s):

Kyeong-Tae Lee ◽

Ara Kim ◽

Goo-Hyun Mun

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Comprehensive Analysis ◽

Thoracodorsal Artery ◽

Thoracodorsal Artery Perforator Flap ◽

Artery Perforator

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A Maxillofacial Surgeon and Trainee's Perspective of the Medial Sural Artery Perforator Flap

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2017.08.115 ◽

2017 ◽

Vol 55 (10) ◽

pp. e124-e125

Author(s):

Nikhil Maini ◽

Jag Dhanda ◽

Brian Bisase ◽

Aakshay Gulati ◽

Laurence Newman ◽

...

Keyword(s):

Perforator Flap ◽

Sural Artery ◽

Artery Perforator

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Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1731764 ◽

2021 ◽

Author(s):

Jourdain D. Artz ◽

Elisa K. Atamian ◽

Clairissa Mulloy ◽

Mark W. Stalder ◽

Jamie Zampell ◽

...

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Imaging Study ◽

Vessel Diameter ◽

Pubic Tubercle ◽

Computed Tomographic ◽

Flap Design ◽

Preoperative Magnetic Resonance ◽

The Mean ◽

Artery Perforator

Abstract Introduction While the originally described transverse profunda artery perforator (tPAP) flap is designed to capture the first profunda perforator, our group hypothesized the dominant perforator may not always be captured in this configuration. This study maps the location of dominant profunda perforators using imaging and cadaveric dissections to determine the probability of capturing dominant perforators with the transverse flap design versus the vertical PAP (vPAP) variant. Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram scans (100 total extremities) were examined from autologous breast reconstruction patients between 2015 and 2019. Profunda perforator characteristics that were examined included the distance from the pubic tubercle to the infragluteal fold (IGF), the distance of the perforators from the IGF, distance posterior to the gracilis, the diameter of the perforator at fascial exit, and total number of perforators present. Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis included mean distance from pubic tubercle, distance posterior to the gracilis, diameter at fascial exit, and total number of perforators. Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm. Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater than 8 cm below the estimated IGF. Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP incorporates multiple perforators with a long pedicle, excellent vessel diameter, and favorable donor-site.

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Anterior Intercostal Artery Perforator Flap as a Simple Technique for Partial Breast Reconstruction: Our Institutional Initial Experience

Tumori Journal ◽

10.1177/0300891620931670 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 40-40

Author(s):

R Amira Maher ◽

Ahmed Gamal Eldin Osman ◽

K Fahmy ◽

Nouf M. Ebied ◽

Reda Eissa

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Perforator Flap ◽

Cosmetic Outcome ◽

University Hospital ◽

Intercostal Artery ◽

Breast Size ◽

Cancer Management ◽

The Mean ◽

Artery Perforator

Background: The oncoplastic surgery has brought new dimensions to breast conserving surgery and added the aesthetic principles of breast surgery to breast cancer management. Recently there's a lot of volume replacement techniques without significant donor site morbidity .The anterior intercostal artery perforator (AICAP) flap is a suitable option in partial breast reconstruction for lower pole tumors in small and medium sized breasts. Objectives: The aim of this study is to report our clinical experience with anterior intercostal perforator flap in partial breast reconstruction Methodology: 25 cases were performed between April 2018 to June 2019 at in Ain shams university hospitals for selected patients with lower breast pole tumors with small and medium sized breast and other option like reduction mMDTmoplasty wasn't favorable for them. Results: A total of 25 patient were selected by the multidisplinary team at Ain shams university hospital for partial breast reconstruction with anterior intercostal artery perforator flap . The mean age of the cases was 45.68 with mean body mass index of 32.32. The mean operative time for the flap was 64 minutes while the hospital stay was ranging from 1-2 days .Follow-up for local recurrence was from 6 to 14 months. There was 1 case with wound complication (4%). The cosmetic outcome was assessed by the MDT and a giving score from 1-5 was used with 1 is the least favorable cosmetic outcome and 5 is the best result 76% of the cases scored 5, 14% scored 4, 8% scored 3. According to patient satisfaction a score from 1 to 5 was used with the score 1 is least satisfied and score 5 represents the most satisfaction level, there was 80% of the patient gave the score 5, 12% of the cases gave the score 4 and 8% of the cases gave the score 3 Conclusions: Based on our experience, partial breast reconstruction using AICAP flap is a reliable option for lower breast tumors in small-to-moderate breast size with perfect cosmetic outcome and negligible rate of complication.

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