Medial sural artery perforator flap—indications, tips and pitfalls

Abstract

Following the description of the medial sural artery free flap by Cavadas et al., the MSAP free flap is proving to be a useful tool for the head and neck reconstructive surgeon. The authors review the available literature for MSAP free flaps in particular related to oral cavity reconstruction and share their technique and experience with the MSAP free flap reconstruction of oral cavity defects. Twenty nine prospective cases of oral cavity reconstruction with MSAP free flaps between October 2015 and May 2020 in a tertiary referral centre are discussed. The principle advantages of the MSAP flap include the favourable thickness (mean 9.29 mm), pliability, pedicle length (mean 12.4 cm) and favourable donor site (primary closure 93%). The mean number of perforators was 1.4. The mean vessel diameter for the artery was 1.43 mm and vein 3.42 mm respectively. The overall complication rate was 17% (5/29 cases). Key challenges include care during flap inset and avoidance of perforator twisting. Implantable dopplers are also recommended for postoperative flap monitoring. Useful technical tips and the recognised challenges in the literature associated with this flap are discussed. Overall, the MSAP flap can be a useful tool in the armamentarium of the head and neck reconstructive surgeon for oral cavity reconstruction.