Research progress of clinical application of medial sural artery perforator flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FANG Jie ¹ , CHEN Buguo ¹ , WU Yao ¹ , TANG Zhaolin ¹ , REN Fei ¹ ,  ZHANG Wenlong ²

1. Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Ren Ci Hospital, Xuzhou Jiangsu, 221000, P.R.China;
2. Department of Hand and Foot Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China;

Corresponding author：

ZHANG Wenlong, Email: zhangwenlong2010@163.com

Keywords：

Medial sural artery perforator flap; defect reconstruction; microsurgery

DOI：

10.7507/1002-1892.202011032

Video：

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Objective To review the research progress of the clinical application of the medial sural artery perforator flap (MSAPF).Methods The relevant domestic and abroad literature on the clinical application of MSAPF was extensively consulted, and the research progress were summarized and analyzed in aspect of its definition, anatomical characteristics, clinical application, surgical resection and improvement, and advantages and disadvantages of flaps, etc.Results MSAPF has the advantages of relatively constant anatomical position, thin flap texture, long vascular pedicle, large vessel diameter, no sacrifice of main blood vessels, concealed donor site, no hair, and fewer complications; it can carry nerves, tendons, and muscles to construct chimeric flaps to repair three-dimensional wounds; and can also repair wounds with high aesthetic and functional requirements such as hand, foot and ankle, head and neck, etc.Conclusion The MSAPF is a versatile, various forms, functional diversification, and three-dimensional flap donor site with various application forms and ideal repair effectiveness.

Citation： FANG Jie, CHEN Buguo, WU Yao, TANG Zhaolin, REN Fei, ZHANG Wenlong. Research progress of clinical application of medial sural artery perforator flap. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 508-513. doi: 10.7507/1002-1892.202011032 Copy

1.	Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg, 1975, 56(3): 243-253.
2.	Johnson PE, Harris GD, Nagle DJ, et al. The sural artery and vein as recipient vessels in free flap reconstruction about the knee. J Reconstr Microsurg, 1987, 3(3): 233-241.
3.	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): 1609-1615.
4.	Tee R, Jeng SF, Chen CC, et al. The medial sural artery perforator pedicled propeller flap for coverage of middle-third leg defects. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1971-1978.
5.	Mughal M, Gabuniya N, Zoccali G, et al. Functional outcomes of the medial sural artery perforator flap in oral cavity reconstruction. Ann Plast Surg, 2020, 85(3): 256-259.
6.	Silva AK, Portugal L, Blair EA. In reference to the medial sural artery perforator flap: A better option in complex head and neck reconstruction? Laryngoscope, 2020, 130(8): E456.
7.	Sue GR, Kao HK, Borrelli MR, et al. The versatile free medial sural artery perforator flap: An institutional experience for reconstruction of the head and neck, upper and lower extremities. Microsurgery, 2020, 40(4): 427-433.
8.	Taufique ZM, Daar DA, Levine JP, et al. Medial sural artery musculocutaneous perforator (MSAP) flap for reconstruction of pharyngoesophageal defects. Otolaryngol Head Neck Surg, 2020, 162(6): 993-995.
9.	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.
10.	Basnet LM, Ghosh SK, Shrestha S, et al. Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery. Surg Radiol Anat, 2018, 40(8): 935-941.
11.	Altaf FM. The anatomical basis of the medial sural artery perforator flaps. West Indian Med J, 2011, 60(6): 622-627.
12.	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.
13.	Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
14.	Potparić Z, Colen LB, Sućur D, et al. The gastrocnemius muscle as a free-flap donor site. Plast Reconstr Surg, 1995, 95(7): 1245-1252.
15.	任志勇, 张维彬, 王辉, 等. 腓肠肌血管的应用解剖和临床应用. 中华显微外科杂志, 2008, 31(5): 372-373.
16.	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.
17.	Song X, Wu H, Zhang W, et al. Medial sural artery perforator flap for postsurgical reconstruction of head and neck cancer. J Reconstr Microsurg, 2015, 31(4): 319-326.
18.	Hallock GG, Sano K. The medial sural MEDIAL GASTROCNEMIUS perforator free flap: an ‘ideal’ prone position skin flap. Ann Plast Surg, 2004, 52(2): 184-187.
19.	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.
20.	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.
21.	Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1267-1275.
22.	谭石, 李敬府, 白志勇, 等. 彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用. 中国临床医学影像学杂志, 2012, 23(7): 488-491.
23.	胡浩良, 李学渊, 费剑荣, 等. Free-style 概念在小腿穿支螺旋桨皮瓣设计及切取中的应用. 中华显微外科杂志, 2017, 40(2): 190-192.
24.	Zhao W, Li Z, Wu L, et al. Medial sural artery perforator flap aided by ultrasonic perforator localization for reconstruction after oral carcinoma resection. J Oral Maxillofac Surg, 2016, 74(5): 1063-1071.
25.	Kosutic D, Pejkovic B, Anderhuber F, et al. Complete mapping of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation. J Plast Reconstr Aesthet Surg, 2012, 65(11): 1530-1536.
26.	He Y, Jin SF, Zhang CP, et al. Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction. Int J Oral Maxillofac Surg, 2014, 43(9): 1064-1068.
27.	He Y, Jin SF, Zhang ZY, et al. A prospective study of medial sural artery perforator flap with computed tomographic angiography-aided design in tongue reconstruction. J Oral Maxillofac Surg, 2014, 72(11): 2351-2365.
28.	Higueras Suñé MC, López Ojeda A, Narváez García JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg, 2011, 64(9): 1207-1213.
29.	Pease NL, Davies A, Townley WA. Free sural artery perforator flap: An occasional gift in oral cavity reconstruction. Head Neck, 2016, 38(7): E2454-E2456.
30.	张功林, 章鸣, 郭翱, 等. 腓肠内侧动脉穿支蒂皮瓣修复膝和小腿上1/3前软组织缺损. 中华显微外科杂志, 2008, 31(4): 246-248.
31.	Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
32.	张功林, 章鸣, 张金福, 等. 腓肠内侧动脉穿支带蒂皮瓣修复髌前软组织缺损. 中华骨科杂志, 2007, 27(2): 144-145.
33.	Umemoto Y, Adachi Y, Ebisawa K. The sural artery perforator flap for coverage of defects of the knee and tibia. Scand J Plast Reconstr Surg Hand Surg, 2005, 39(4): 209-212.
34.	Ling BM, Wettstein R, Staub D, et al. The medial sural artery perforator flap: The first choice for soft-tissue reconstruction about the knee. J Bone Joint Surg (Am), 2018, 100(3): 211-217.
35.	Mazur N, Osinga R, Lo S. Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction. BMJ Case Rep, 2020, 13(2): e233352.
36.	John JR. Medial sural artery V-Y advancement flap: bridging a learning curve. J Reconstr Microsurg, 2013, 29(7): 491-492.
37.	Ranson J, Rosich-Medina A, Amin K, et al. Medial sural artery perforator flap: Using the superficial venous system to minimize flap congestion. Arch Plast Surg, 2015, 42(6): 813-815.
38.	Taufique ZM, Daar DA, Cohen LE, et al. The medial sural artery perforator flap: A better option in complex head and neck reconstruction? Laryngoscope, 2019, 129(6): 1330-1336.
39.	Daar DA, Abdou SA, Cohen JM, 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): 393e-403e.
40.	Chalmers RL, Rahman KM, Young S, et al. The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience. J Plast Reconstr Aesthet Surg, 2016, 69(5): 687-693.
41.	Molina AR, Citron I, Chinaka F, et al. Calf perforator flaps: A freestyle solution for oral cavity reconstruction. Plast Reconstr Surg, 2017, 139(2): 459-465.
42.	Lin CH, Lin CH, Lin YT, et al. The medial sural artery perforator flap: a versatile donor site for hand reconstruction. J Trauma, 2011, 70(3): 736-743.
43.	Xie RG, Gu JH, Gong YP, et al. Medial sural artery perforator flap for repair of the hand. J Hand Surg (Eur Vol), 2007, 32(5): 512-517.
44.	Jandali Z, Lam MC, Aganloo K, et al. The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small-to-moderate size defects of the foot and ankle. Microsurgery, 2018, 38(1): 34-45.
45.	Teven CM, Yu JW, Zhao LC, et al. Extended medial sural artery perforator free flap for groin and scrotal reconstruction. Arch Plast Surg, 2020, 47(4): 354-359.
46.	Yen CI, Yang JY, Chang CS, et al. Nose resurfacing with free fasciocutaneous flaps in burns patients. Microsurgery, 2018, 38(6): 659-666.
47.	Zheng H, Liu J, Dai X, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aesthet Surg, 2015, 68(4): 565-570.
48.	Lee CH, Chang NT, Hsiao JC, et al. Extended use of chimeric medial sural artery perforator flap for 3-dimensional defect reconstruction. Ann Plast Surg, 2019, 82(1S Suppl 1): S86-S94.
49.	Han SE, Lee KT, Mun GH. Muscle-chimaeric medial sural artery perforator flap: a new design for complex three-dimensional knee defect. J Plast Reconstr Aesthet Surg, 2014, 67(4): 571-574.
50.	Innocenti M, Cardin-Langlois E, Menichini G, et al. Gastrocnaemius-propeller extended miocutanous flap: a new chimaeric flap for soft tissue reconstruction of the knee. J Plast Reconstr Aesthet Surg, 2014, 67(2): 244-251.
51.	Shen XQ, Lv Y, Shen H, et al. Endoscope-assisted medial sural artery perforator flap for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(8): 1059-1065.
52.	Tsou HJ, Tu CP, Chen YF, et al. An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius. Case Reports Plast Surg Hand Surg, 2019, 6(1): 47-50.
53.	Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.

1. Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg, 1975, 56(3): 243-253.
2. Johnson PE, Harris GD, Nagle DJ, et al. The sural artery and vein as recipient vessels in free flap reconstruction about the knee. J Reconstr Microsurg, 1987, 3(3): 233-241.
3. 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): 1609-1615.
4. Tee R, Jeng SF, Chen CC, et al. The medial sural artery perforator pedicled propeller flap for coverage of middle-third leg defects. J Plast Reconstr Aesthet Surg, 2019, 72(12): 1971-1978.
5. Mughal M, Gabuniya N, Zoccali G, et al. Functional outcomes of the medial sural artery perforator flap in oral cavity reconstruction. Ann Plast Surg, 2020, 85(3): 256-259.
6. Silva AK, Portugal L, Blair EA. In reference to the medial sural artery perforator flap: A better option in complex head and neck reconstruction? Laryngoscope, 2020, 130(8): E456.
7. Sue GR, Kao HK, Borrelli MR, et al. The versatile free medial sural artery perforator flap: An institutional experience for reconstruction of the head and neck, upper and lower extremities. Microsurgery, 2020, 40(4): 427-433.
8. Taufique ZM, Daar DA, Levine JP, et al. Medial sural artery musculocutaneous perforator (MSAP) flap for reconstruction of pharyngoesophageal defects. Otolaryngol Head Neck Surg, 2020, 162(6): 993-995.
9. 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.
10. Basnet LM, Ghosh SK, Shrestha S, et al. Anatomical study of medial sural artery and its perforators in Nepalese: an aid to reconstructive surgery. Surg Radiol Anat, 2018, 40(8): 935-941.
11. Altaf FM. The anatomical basis of the medial sural artery perforator flaps. West Indian Med J, 2011, 60(6): 622-627.
12. 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.
13. Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
14. Potparić Z, Colen LB, Sućur D, et al. The gastrocnemius muscle as a free-flap donor site. Plast Reconstr Surg, 1995, 95(7): 1245-1252.
15. 任志勇, 张维彬, 王辉, 等. 腓肠肌血管的应用解剖和临床应用. 中华显微外科杂志, 2008, 31(5): 372-373.
16. 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.
17. Song X, Wu H, Zhang W, et al. Medial sural artery perforator flap for postsurgical reconstruction of head and neck cancer. J Reconstr Microsurg, 2015, 31(4): 319-326.
18. Hallock GG, Sano K. The medial sural MEDIAL GASTROCNEMIUS perforator free flap: an ‘ideal’ prone position skin flap. Ann Plast Surg, 2004, 52(2): 184-187.
19. 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.
20. 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.
21. Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9): 1267-1275.
22. 谭石, 李敬府, 白志勇, 等. 彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用. 中国临床医学影像学杂志, 2012, 23(7): 488-491.
23. 胡浩良, 李学渊, 费剑荣, 等. Free-style 概念在小腿穿支螺旋桨皮瓣设计及切取中的应用. 中华显微外科杂志, 2017, 40(2): 190-192.
24. Zhao W, Li Z, Wu L, et al. Medial sural artery perforator flap aided by ultrasonic perforator localization for reconstruction after oral carcinoma resection. J Oral Maxillofac Surg, 2016, 74(5): 1063-1071.
25. Kosutic D, Pejkovic B, Anderhuber F, et al. Complete mapping of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation. J Plast Reconstr Aesthet Surg, 2012, 65(11): 1530-1536.
26. He Y, Jin SF, Zhang CP, et al. Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction. Int J Oral Maxillofac Surg, 2014, 43(9): 1064-1068.
27. He Y, Jin SF, Zhang ZY, et al. A prospective study of medial sural artery perforator flap with computed tomographic angiography-aided design in tongue reconstruction. J Oral Maxillofac Surg, 2014, 72(11): 2351-2365.
28. Higueras Suñé MC, López Ojeda A, Narváez García JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg, 2011, 64(9): 1207-1213.
29. Pease NL, Davies A, Townley WA. Free sural artery perforator flap: An occasional gift in oral cavity reconstruction. Head Neck, 2016, 38(7): E2454-E2456.
30. 张功林, 章鸣, 郭翱, 等. 腓肠内侧动脉穿支蒂皮瓣修复膝和小腿上1/3前软组织缺损. 中华显微外科杂志, 2008, 31(4): 246-248.
31. Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
32. 张功林, 章鸣, 张金福, 等. 腓肠内侧动脉穿支带蒂皮瓣修复髌前软组织缺损. 中华骨科杂志, 2007, 27(2): 144-145.
33. Umemoto Y, Adachi Y, Ebisawa K. The sural artery perforator flap for coverage of defects of the knee and tibia. Scand J Plast Reconstr Surg Hand Surg, 2005, 39(4): 209-212.
34. Ling BM, Wettstein R, Staub D, et al. The medial sural artery perforator flap: The first choice for soft-tissue reconstruction about the knee. J Bone Joint Surg (Am), 2018, 100(3): 211-217.
35. Mazur N, Osinga R, Lo S. Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction. BMJ Case Rep, 2020, 13(2): e233352.
36. John JR. Medial sural artery V-Y advancement flap: bridging a learning curve. J Reconstr Microsurg, 2013, 29(7): 491-492.
37. Ranson J, Rosich-Medina A, Amin K, et al. Medial sural artery perforator flap: Using the superficial venous system to minimize flap congestion. Arch Plast Surg, 2015, 42(6): 813-815.
38. Taufique ZM, Daar DA, Cohen LE, et al. The medial sural artery perforator flap: A better option in complex head and neck reconstruction? Laryngoscope, 2019, 129(6): 1330-1336.
39. Daar DA, Abdou SA, Cohen JM, 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): 393e-403e.
40. Chalmers RL, Rahman KM, Young S, et al. The medial sural artery perforator flap in intra-oral reconstruction: A Northeast experience. J Plast Reconstr Aesthet Surg, 2016, 69(5): 687-693.
41. Molina AR, Citron I, Chinaka F, et al. Calf perforator flaps: A freestyle solution for oral cavity reconstruction. Plast Reconstr Surg, 2017, 139(2): 459-465.
42. Lin CH, Lin CH, Lin YT, et al. The medial sural artery perforator flap: a versatile donor site for hand reconstruction. J Trauma, 2011, 70(3): 736-743.
43. Xie RG, Gu JH, Gong YP, et al. Medial sural artery perforator flap for repair of the hand. J Hand Surg (Eur Vol), 2007, 32(5): 512-517.
44. Jandali Z, Lam MC, Aganloo K, et al. The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small-to-moderate size defects of the foot and ankle. Microsurgery, 2018, 38(1): 34-45.
45. Teven CM, Yu JW, Zhao LC, et al. Extended medial sural artery perforator free flap for groin and scrotal reconstruction. Arch Plast Surg, 2020, 47(4): 354-359.
46. Yen CI, Yang JY, Chang CS, et al. Nose resurfacing with free fasciocutaneous flaps in burns patients. Microsurgery, 2018, 38(6): 659-666.
47. Zheng H, Liu J, Dai X, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aesthet Surg, 2015, 68(4): 565-570.
48. Lee CH, Chang NT, Hsiao JC, et al. Extended use of chimeric medial sural artery perforator flap for 3-dimensional defect reconstruction. Ann Plast Surg, 2019, 82(1S Suppl 1): S86-S94.
49. Han SE, Lee KT, Mun GH. Muscle-chimaeric medial sural artery perforator flap: a new design for complex three-dimensional knee defect. J Plast Reconstr Aesthet Surg, 2014, 67(4): 571-574.
50. Innocenti M, Cardin-Langlois E, Menichini G, et al. Gastrocnaemius-propeller extended miocutanous flap: a new chimaeric flap for soft tissue reconstruction of the knee. J Plast Reconstr Aesthet Surg, 2014, 67(2): 244-251.
51. Shen XQ, Lv Y, Shen H, et al. Endoscope-assisted medial sural artery perforator flap for head and neck reconstruction. J Plast Reconstr Aesthet Surg, 2016, 69(8): 1059-1065.
52. Tsou HJ, Tu CP, Chen YF, et al. An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius. Case Reports Plast Surg Hand Surg, 2019, 6(1): 47-50.
53. Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.

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