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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2013 December;24(3):143-6
Medial sural artery perforator flap: early report of clinical experience
Girotto R. 1, Fianchini G. 2, Messi M. 1, Mancini P. 1, Lupi E. 1, Balercia P. 1
1 Maxillo‑Facial Surgery Department, Regional Hospital Umberto I Lancisi‑Salesi, Ancona, Italy;
2 Division of Maxillo‑Facial Surgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
AIM: In the attempt to identify a possible option other than radial forearm flap or anterolateral thigh flap (ALT) flap for head and neck reconstruction recent literature lead us to consider the medial sural perforator flap as an important tool in reconstructive surgery.
METHODS: From January 2010 to May 2010 we admitted to our Department 3 patients for whom we chose the medial sural artery perforator flap as an alternative reconstructive option for oral cancer surgery. The poor Allen test response and the thickness of the patients’ thighs limited our reconstructive possibilities since ALT and radial forearm are daily practice workhorses. The average time for harvesting this flap was approximately 1 hour and a half for a pedicle length from 6 to 9 cm. The hand-held Doppler examination allowed us to identify the perforators along the lower border of the medial gastrocnemius muscle. The average size of the skin paddle was 5x7 cm.
RESULTS: The postoperative period was uneventful and the healing was good both in the intraoral and calf regions.
CONCLUSION: This flap is a good alternative for head and neck reconstructive surgery because of limited thickness and good pliability. The skin paddle can be selected according to the location and size of a reliable perforator as in any conventional perforators flap. It requires familiarity with intramuscular dissection, difficult surgical position and anatomical region. No functional impairment of the harvesting site was observed.