MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR REPAIR OF DEFECT AFTER TONGUE CANCER ABLATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAOWenquan ¹ , LIUJianhua ¹ , LIUChao ² ,  LIZhiyong ¹

1. Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310003, P. R. China;
2. Department of Oral and Maxillofacial Surgery, Stomatology Hospital, College of Medicine, Zhejiang University;

Corresponding author：

LIZhiyong, Email: zjulizhy@163.com

Keywords：

Medial sural artery; Perforator flap; Tongue defect; Soft tissue repair

DOI：

10.7507/1002-1892.20150070

Video：

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Objective To investigate the effectiveness of medial sural artery perforator free flap (MSAP) for repairing defect after tongue cancer ablation. Methods Between March 2013 and April 2014, the defects after tongue carcinoma resection were repaired with MSAP in 12 patients, including 8 cases of high or medium differentiated squamous cell carcinoma (SCC) and 4 cases of moderately-poor differentiated SCC. There were 7 males and 5 females with a median age of 55 years (range, 45-68 years). The disease duration ranged from 2.0 to 8.5 months (mean, 4.3 months). The tumor located at the tongue edge in 8 cases and at the tongue abdomen in 4 cases (mouth floor infiltration in 1 case). According to TNM stage, 7 cases were rated as T₂N₀M₀, 2 cases as T₂N₁M₀, 2 cases as T₃N₁M₀, and 1 case as T₄N₁M₀. The size of tumor ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The size of MSAP varied from 4.0 cm×3.5 cm to 6.5 cm×6.0 cm. Results The time of total operation ranged from 5.5 to 8.3 hours (mean, 6.8 hours), and flap harvesting time ranged from 54 to 85 minutes (mean, 65.6 minutes). The other flaps survived except 1 case of vein crisis. All the patients were followed up 6-18 months (mean, 13.7 months). With time passing, the pronunciation got better, and the skin showed mucosa-like change; the patients were capable of normal language exchange at 6 months after operation. No obvious scar on the leg or limitation of limb motion was observed. Conclusion The MSAP is reliable for repair of defect after tongue cancer ablation, with the advantages of satisfactory recovery of tongue appearance, language function, and less donor site morbidity.

Citation： ZHAOWenquan, LIUJianhua, LIUChao, LIZhiyong. MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR REPAIR OF DEFECT AFTER TONGUE CANCER ABLATION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 331-334. doi: 10.7507/1002-1892.20150070 Copy

1.	Horta R, Valença-Filipe R, Nascimento R, et al. Perforator-based propeller flap with venous axial supercharging for reconstruction of a leg defect. Injury, 2014, 45(12):2118-2119.
2.	周晓, 芮永军, 许亚军, 等. 大鱼际微型穿支皮瓣在拇指近节指腹挛缩修复中的应用. 中国修复重建外科杂志, 2012, 26(11):1405-1406.
3.	Chen F, Liu J, Lv D, et al. Reconstruction of the oropharynx with free posterior tibial flap after tonsillar cancer extirpation. J Oral Maxillofac Surg, 2014, 72(10):2083-2091.
4.	Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
5.	Hallock GG. Medial sural artery perforator free flap:legitimate use as a solution for the ipsilateral distal lower extremity defect. J Reconstr Microsurg, 2014, 30(3):187-192.
6.	Chen SL, Chuang CJ, Chou TD, et al. Free medial sural artery perforator flap for ankle and foot reconstruction. Ann Plast Surg, 2005, 54(1):39-43.
7.	Xie XT, Chai YM. Medial sural artery perforator flap. Ann Plast Surg, 2012, 68(1):105-110.
8.	Chen SL, Chen TM, Dai NT, et al. Medial sural artery perforator flap for tongue and floor of mouth reconstruction. Head Neck, 2008, 30(3):351-357.
9.	毛驰, 张雷, 崔秋菊, 等. 游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究. 中华口腔医学杂志, 2011, 46(12):742-746.
10.	Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5):501-505.
11.	Thione A, Valdatta L, Buoro M, et al. The medial sural artery perforators:anatomic basis for a surgical plan. Ann Plast Surg, 2004, 53(3):250-255.
12.	Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap:an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5):1609-1618.
13.	Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3):125-129.
14.	Shimizu F, Kato A, Sato H, et al. Sural perforator flap:assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery, 2009, 29(4):253-258.
15.	Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4):1135-1145.
16.	Wong MZ, Wong CH, Tan BK, et al. Surgical Anatomy of the Medial Sural Artery Perforator Flap. Journal of Reconstructive Microsurgery, 2012, 28(8):555-559.
17.	肖海涛, 时莹瑜, 王怀胜, 等. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用. 中国修复重建外科杂志, 2013, 27(2):178-181.
18.	Kao HK, Chang KP, Wei FC, 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):1125-1132.

1. Horta R, Valença-Filipe R, Nascimento R, et al. Perforator-based propeller flap with venous axial supercharging for reconstruction of a leg defect. Injury, 2014, 45(12):2118-2119.
2. 周晓, 芮永军, 许亚军, 等. 大鱼际微型穿支皮瓣在拇指近节指腹挛缩修复中的应用. 中国修复重建外科杂志, 2012, 26(11):1405-1406.
3. Chen F, Liu J, Lv D, et al. Reconstruction of the oropharynx with free posterior tibial flap after tonsillar cancer extirpation. J Oral Maxillofac Surg, 2014, 72(10):2083-2091.
4. Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
5. Hallock GG. Medial sural artery perforator free flap:legitimate use as a solution for the ipsilateral distal lower extremity defect. J Reconstr Microsurg, 2014, 30(3):187-192.
6. Chen SL, Chuang CJ, Chou TD, et al. Free medial sural artery perforator flap for ankle and foot reconstruction. Ann Plast Surg, 2005, 54(1):39-43.
7. Xie XT, Chai YM. Medial sural artery perforator flap. Ann Plast Surg, 2012, 68(1):105-110.
8. Chen SL, Chen TM, Dai NT, et al. Medial sural artery perforator flap for tongue and floor of mouth reconstruction. Head Neck, 2008, 30(3):351-357.
9. 毛驰, 张雷, 崔秋菊, 等. 游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究. 中华口腔医学杂志, 2011, 46(12):742-746.
10. Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5):501-505.
11. Thione A, Valdatta L, Buoro M, et al. The medial sural artery perforators:anatomic basis for a surgical plan. Ann Plast Surg, 2004, 53(3):250-255.
12. Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap:an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5):1609-1618.
13. Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3):125-129.
14. Shimizu F, Kato A, Sato H, et al. Sural perforator flap:assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery, 2009, 29(4):253-258.
15. Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4):1135-1145.
16. Wong MZ, Wong CH, Tan BK, et al. Surgical Anatomy of the Medial Sural Artery Perforator Flap. Journal of Reconstructive Microsurgery, 2012, 28(8):555-559.
17. 肖海涛, 时莹瑜, 王怀胜, 等. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用. 中国修复重建外科杂志, 2013, 27(2):178-181.
18. Kao HK, Chang KP, Wei FC, 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):1125-1132.

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MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR REPAIR OF DEFECT AFTER TONGUE CANCER ABLATION

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