Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2024; 57(02): 140-146
DOI: 10.1055/s-0044-1782201
Original Article

A Cadaveric Study on Perforator Anatomy of the Medial Sural Artery Perforator Flap

Helen Mary Titus
1   Department of Plastic and Reconstructive Surgery, Government Medical College Kottayam, Kottayam, Kerala, India
,
Sarath Radhakrishnapillai Sreedevi
1   Department of Plastic and Reconstructive Surgery, Government Medical College Kottayam, Kottayam, Kerala, India
,
Sabu Chaniveliyil Parameswaran
1   Department of Plastic and Reconstructive Surgery, Government Medical College Kottayam, Kottayam, Kerala, India
,
Lekshmi Malathi 
1   Department of Plastic and Reconstructive Surgery, Government Medical College Kottayam, Kottayam, Kerala, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The medial sural artery perforator (MSAP) flap was described by Cavadas et al in 2001. The aim of this study was to analyze the flap characteristics in the regional population and was planned as a cadaveric dissection study.

Methods Thirty-three legs of fresh cadavers were studied for perforator characteristics, length, and origin of pedicle and skin paddle thickness. Observations were documented and analyzed.

Results Seventeen right legs (51.5%) and sixteen left legs (48.5%) were studied. Twenty-five pedicles originated from popliteal artery (86.2%) and four (13.8%) from the common sural trunk. No perforators were seen in four legs. The mean number of perforators is 2 (0–6). The mean distance of perforator from midpoint of popliteal fossa was 10.7 cm (8–13 cm) and from posterior midline it was 3.2 cm. The mean size of the perforator was 1.1 ± 0.8 mm (0.8–1.5 mm). The mean pedicle length was 9.3 ± 1.3 cm. The mean flap thickness was 4.3 ± 0.7 mm (3.0–5.5 mm). There was no correlation for flap or perforator characteristics with side of leg.

Conclusion This study concludes that MSAP is a good flap in terms of perforator characteristics, pedicle length, and flap thickness, when a medium sized thin flap with long pedicle is needed. The location of perforator on calf varies in different population. Being a perforator flap, anatomical variability is common and should be thought of while choosing this flap.

Keywords

perforator anatomy - MSAP - musculocutaneous perforators - gastrocnemius

Note

This study was submitted as thesis for MCh Plastic Surgery to Kerala University of Health Science by the first author.


Authors' Contributions

All the authors participated in designing this study. H.M.T. and S.R.S. did the data collection and prepared the manuscript. H.M.T. compiled and analyzed the data. S.C.P. and L.M. supervised data collection and analysis, reviewed, and approved the manuscript.


IRB Approval

This study was approved by the Institutional Review Board of Government Medical College Kottayam (38/2021).




Publication History

Article published online:
18 March 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Walton RL, Bunkis J. The posterior calf fasciocutaneous free flap. Plast Reconstr Surg 1984; 74 (01) 76-85
    CrossrefPubMedGoogle Scholar
  • 2 Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, Navarro-Monzonís A, Soler-Nomdedeu S, Martínez-Soriano F. The medial sural artery perforator free flap. Plast Reconstr Surg 2001; 108 (06) 1609-1615 , discussion 1616–1617
    CrossrefPubMedGoogle Scholar
  • 3 Nugent M, Endersby S, Kennedy M, Burns A. 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 2015; 53 (05) 461-463
    CrossrefPubMedGoogle Scholar
  • 4 Al-Himdani S, Din A, Wright TC, Wheble G, Chapman TWL, Khan U. The medial sural artery perforator (MSAP) flap: a versatile flap for lower extremity reconstruction. Injury 2020; 51 (04) 1077-1085
    CrossrefPubMedGoogle Scholar
  • 5 Chen S-L, Chen T-M, Lee C-H. Free medial sural artery perforator flap for resurfacing distal limb defects. J Trauma 2005; 58 (02) 323-327
    CrossrefPubMedGoogle Scholar
  • 6 Agrawal G, Gupta A, Chaudhary V, Qureshi F, Choraria A, Dubey H. Medial sural artery perforator flap for head and neck reconstruction. Ann Maxillofac Surg 2018; 8 (01) 61-65
    CrossrefPubMedGoogle Scholar
  • 7 Gulati A, Patel P, Maini N. et al. Medial sural artery perforator flap—indications, tips and pitfalls. Front Oral Maxillofac Med 2021; 3: 26
    CrossrefGoogle Scholar
  • 8 Huang X, Xu J, Yang H, Shi H. Reconstruction of thumb defects with medial sural artery perforator flap: case series. Ann Transl Med 2021; 9 (08) 658
    CrossrefPubMedGoogle Scholar
  • 9 Taufique ZM, Daar DA, Levine JP, Jacobson AS. Medial sural artery musculocutaneous perforator (MSAP) flap for reconstruction of pharyngoesophageal defects. Otolaryngol Head Neck Surg 2020; 162 (06) 993-995
    CrossrefPubMedGoogle Scholar
  • 10 Tsetsonis CH, Kaxira OS, Laoulakos DH, Spiliopoulou CA, Koutselinis AS. The arterial communication between the gastrocnemius muscle heads: a fresh cadaveric study and clinical implications. Plast Reconstr Surg 2000; 105 (01) 94-98
    CrossrefPubMedGoogle Scholar
  • 11 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56 (03) 243-253
    CrossrefPubMedGoogle Scholar
  • 12 Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg 2001; 47 (05) 517-522
    CrossrefPubMedGoogle Scholar
  • 13 Okamoto H, Sekiya I, Mizutani J, Otsuka T. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (03) 125-129
    CrossrefPubMedGoogle Scholar
  • 14 Luca-Pozner V, Delgove A, Kerfant N, Karra A, Herlin C, Chaput B. Medial sural artery perforator flap for leg and knee coverage: extended skin paddle with 2 perforators. Ann Plast Surg 2020; 85 (06) 650-655
    CrossrefPubMedGoogle Scholar
  • 15 Tee R, Jeng S-F, Chen C-C, Shih H-S. 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
    CrossrefPubMedGoogle Scholar
  • 16 Narayan N, Berner JE, Saeed A, Zanchetta F, Troisi L. Outcomes of the pedicled medial sural artery perforator flap for soft tissue reconstruction around the knee: when to use it and how to look after it. J Hand Microsurg 2020; 14 (03) 216-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Hallock GG. The medial sural artery perforator flap: a historical trek from ignominious to “workhorse”. Arch Plast Surg 2022; 49 (02) 240-252
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Altaf FM. The anatomical basis of the medial sural artery perforator flaps. West Indian Med J 2011; 60 (06) 622-627
    PubMedGoogle Scholar
  • 19 Shimizu F, Kato A, Sato H, Taneda H. Sural perforator flap: assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery 2009; 29 (04) 253-258
    CrossrefPubMedGoogle Scholar
  • 20 Kao H-K, Chang K-P, Wei F-C, Cheng M-H. Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions. Plast Reconstr Surg 2009; 124 (04) 1125-1132
    CrossrefPubMedGoogle Scholar
  • 21 Kim JT. New nomenclature concept of perforator flap. Br J Plast Surg 2005; 58 (04) 431-440
    CrossrefPubMedGoogle Scholar
  • 22 Wang X, Mei J, Pan J, Chen H, Zhang W, Tang M. Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast Reconstr Surg 2013; 131 (01) 95-105
    CrossrefPubMedGoogle Scholar
  • 23 Ngo KX, Vo HT, Nguyen DT, Doan HT. The basic anatomy of the medial sural artery perforator flaps in Vietnamese adults. Ann Med Surg (Lond) 2022; 79 (June): 103996
    PubMedGoogle Scholar
  • 24 Chiu T. Medial Sural Artery Perforator Flap. In: Andrew Van Hasselt and Eddy WY Wong, eds. Head & Neck Dissection and Reconstruction Manual. The Chinese University of Hong Kong; 2015: 117-124
    Google Scholar