Augmenting the Reliability and Versatility of Medial Sural Artery Perforator Flap

Hsiang-Shun Shih ； Jill Chen ； Chien-Chung Chen

《E-Da Medical Journal》 10卷2期 (2023/06) Pp. 9-15

https://doi.org/10.6966/EDMJ.202306_10(2).0002

摘要

Objectives: Medial sural artery perforator (MSAP) flap is considered as one of the best options for reconstructing defects that require thin and pliable coverage. However, higher failure rate precludes this flap from gaining consensus as the first choice. This study focuses on increasing the reliability of the flap and expanding its versatility to cover even middle-third-leg defects. Methods: A retrospective study was performed to analyze patients who underwent medial sural artery perforator flap surgery between 2016 and 2019. The data collected included demographics, surgical indications, operative details, and outcomes. Descriptive statistics were used to assess outcomes. Results: Out of the total 86 patients enrolled in the study, eight (9.4%) were excluded because no sizeable perforators were found. Seventy-eight patients underwent medial sural artery flap reconstruction with 63 free and 15 pedicled flaps. Four patients with middle-third leg defects were reconstructed with a "pedicled propeller MSAP flap". There were two flap failures, and the overall success rate was 97.4%. Conclusions: MSAP flap is reliable for the reconstruction of small- to medium-sized defects that require thin skin coverage. Careful flap selection and proper techniques are key factors in increasing its reliability. Conversion to another flap is indicated if no sizable perforators can be found. The "pedicled propeller flap" technique allows successful coverage even in middle-third leg defects.

關鍵字

medial sural artery perforator flap ； reliability ； versatility

參考文獻

Koshima I, Soeda S: Inferior epigastric artery skin flaps without rectus abdominis muscle. British journal of plastic surgery. 1989; 42(6): 645-8.

Khan FN, Spiegel AJ: The Evolution of Perforator Flaps. Seminars in Plastic Surgery. 2006; 20(2): 53-5.

Koshima I, Nanba Y, Tsutsui T, et al: Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir. 2002; 34(4): 251-6.

Wallace CG, Kao HK, Jeng SF, et al: Free-style flaps: a further step forward for perforator flap surgery. Plastic and reconstructive surgery. 2009 ;124(6 Suppl): e419-26.

Lin CH, Lin CH, Lin YT, et al: The medial sural artery perforator flap: a versatile donor site for hand reconstruction. The Journal of trauma. 2011; 70(3): 736-43.