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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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