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Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps

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Abstract

Purpose

It is known that the vascular perforators upon which the medial sural artery perforator (MSAP) flap is based are subject to considerable variation. This study seeks to evaluate the use of colour flow Doppler (CFD) as an imaging technique to establish the presence of suitable vessels, the discriminatory findings from that imaging, the rate of flap abandonment and flap complications.

Methods

All patients undergoing MSAP in our institution since 2015 had a pre-operative CFD using a standardised technique. A prior group of 22 patients not having CFD acted as a control group. Data were  collected prospectively.

Results

Fourteen patients had CFD. In one patient, no suitable vessels were found. In 13 patients, vessels of suitable size and position were identified, which then correlated precisely with operative findings. Three had suitable vessels in one leg only. No flaps in the CFD group were abandoned. One flap in the CFD group was partially lost. One flap in the prior control group was abandoned.

Conclusions

CFD provided reliable discriminatory information to decide on flap suitability/which leg and correlated precisely with operative findings, with no flap abandonment. Flap survival rate was very high.

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References

  1. Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-De la Cámara A et al (2001) The medial sural artery perforator free flap. Plast Reconstr Surg 108(6):1609–1615. https://doi.org/10.1097/00006534-200111000-00027

    Article  CAS  PubMed  Google Scholar 

  2. Kosutic D, Pejkovic B, Anderhuber F et al (2012) Complete map** of lateral and medial sural artery perforators: anatomical study with Duplex-Doppler ultrasound correlation. J Plast Reconstr Aesthet Surg 65(11):1530–1536. https://doi.org/10.1016/j.bjps.2014.05.016

    Article  PubMed  Google Scholar 

  3. Dusseldorp JR, Pham QJ, Ngo Q et al (2014) Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg 67(9):1267–1275. https://doi.org/10.1016/j.bjps.2012.04.045

    Article  PubMed  Google Scholar 

  4. Tuncer FB, Sacak B, Cavus Ozkan M, Celebiler OB (2017) An anatomical variation of the MSAP flap: single direct cutaneous perforator in the posterior calf region. Microsurgery 37(5):465–466. https://doi.org/10.1002/micr.30090

    Article  PubMed  Google Scholar 

  5. Nugent M, Endersby S, Kennedy M, Burns A (2015) Early experience with the medial sural artery perforator flap as an alternative to the radial forearm flap for reconstruction in the head and neck. Br J Oral Maxillofac Surg 53(5):461–463. https://doi.org/10.1016/j.bjoms.2015.02.023

    Article  CAS  PubMed  Google Scholar 

  6. Blondeel PN, Beyens G, Verhaeghe R et al (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51(3):202–209. https://doi.org/10.1016/S0007-1226(98)80010-6

    Article  CAS  PubMed  Google Scholar 

  7. He Y, ** SF, Zhang ZY et al (2014) A prospective study of medial sural artery perforator flap with computed tomographic angiography-aided design in tongue reconstruction. J Oral Maxillofac Surg 72(11):2351–2365. https://doi.org/10.1016/j.joms.2014.05.019

    Article  PubMed  Google Scholar 

  8. Zhao W, Li Z, Wu L et al (2016) Medial sural artery perforator flap aided by ultrasonic perforator localization for reconstruction after oral carcinoma resection. J Oral Maxillofac Surg 74(5):1063–1071. https://doi.org/10.1016/j.joms.2015.11.011

    Article  PubMed  Google Scholar 

  9. Mehta D, Nugent M, Endersby S (2017) Use of colour flow Doppler in locating the optimum donor site for perforator free flap reconstruction. Br J Oral Maxillofac Surg e125. https://doi.org/10.1016/j.bjoms.2017.08.117

  10. Taufique ZM, Daar DA, Cohen LE et al (2019) The medial sural artery perforator flap: a better option in complex head and neck reconstruction? Laryngoscope 129(6):1330–1336. https://doi.org/10.1002/lary.27652

    Article  PubMed  Google Scholar 

  11. Toyserkani NM, Sørensen JA (2015) Medial sural artery perforator flap: a challenging free flap. Eur J Plast Surg 38(5):391–396. https://doi.org/10.1007/s00238-015-1110-5

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hallock GG (2003) Doppler sonography and color duplex imaging for planning a perforator flap. Clin Plast Surg 30(3):347–357. https://doi.org/10.1016/s0094-1298(03)00036-1

    Article  PubMed  Google Scholar 

  13. Ho MW, Nugent M, Puglia F et al (2019) Results of flap reconstruction: categorisation to reflect outcomes and process in the management of head and neck defects. Br J Oral Maxillofac Surg 57(9):935–937. https://doi.org/10.1016/j.bjoms.2019.08.005

    Article  CAS  PubMed  Google Scholar 

  14. Daar DA, Abdou SA, Cohen JM et al (2019) Is the medial sural artery perforator flap a new workhorse flap? A systematic review and meta-analysis. Plast Reconstr Surg 143(2):393e–403e. https://doi.org/10.1097/PRS.0000000000005204

    Article  CAS  PubMed  Google Scholar 

  15. Shaw RJ, Batstone MD, Blackburn TK et al (2010) Preoperative doppler assessment of perforator anatomy in the anterolateral thigh flap. Br J Oral Maxillofac Surg 48(6):419–22. https://doi.org/10.1016/j.bjoms.2009.08.016

    Article  PubMed  Google Scholar 

  16. Martinez JG, Perez AT, Vega MG et al (2020) Preoperative vascular planning of free flaps: comparative study of computed tomographic angiography, color Doppler ultrasonography and hand-held Doppler. Plast Reconstr Surg 146(2):227–237. https://doi.org/10.1097/PRS.0000000000006966

    Article  CAS  Google Scholar 

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Correspondence to Ben J. Steel.

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This study was performed in line with the principles of the Declaration of Helsinki. The clinical effectiveness Department at Sunderland Royal Hospital granted permission for this audit-based study.

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Steel, B.J., Mehta, D., Nugent, M. et al. Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps. Oral Maxillofac Surg 27, 655–659 (2023). https://doi.org/10.1007/s10006-022-01108-4

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  • DOI: https://doi.org/10.1007/s10006-022-01108-4

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