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. 2023 May 29;50(3):264-273.
doi: 10.1055/a-2059-4009. eCollection 2023 May.

The Medial Sural Artery Perforator Flap versus Other Free Flaps in Head and Neck Reconstruction: A Systematic Review

Yasser Al Omran  1 , Ellie Evans  1 , Chloe Jordan  2 , Tiffanie-Marie Borg  3 , Samar AlOmran  4 , Sarvnaz Sepehripour  1 , Mohammed Ali Akhavani  1
Affiliations

The Medial Sural Artery Perforator Flap versus Other Free Flaps in Head and Neck Reconstruction: A Systematic Review

Yasser Al Omran et al. Arch Plast Surg. .

Abstract

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps ( p = 0.0006) but no statistical difference in speech and swallowing function following reconstruction ( p = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.

Keywords: head and neck; microsurgery; reconstruction.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Landmarks to locate the perforators of the medial sural artery perforator flap. The perforators are typically concentrated at an area ∼4.5 cm from the midline and 8–12 cm from the popliteal fossa, along a line drawn from the midline of the popliteal crease down to the medial malleolus.
Fig. 2
Fig. 2
Raised medial sural artery perforator flap.
Fig. 3
Fig. 3
Number of articles published and indexed by Scopus per year under the search term “medial sural artery perforator flap.”
Fig. 4
Fig. 4
PRISMA diagram showing status of searched articles for review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Fig. 5
Fig. 5
Forrest plot comparing donor-site function and appearance outcomes of the medial sural artery perforator flap vs comparator flaps (radial forearm free flap and anterolateral thigh flap). A Mantel–Haenszel fixed-effects model was used. Odds ratios are shown with 95% confidence intervals.
Fig. 6
Fig. 6
Forrest plot comparing speech and swallowing function outcomes of the medial sural artery perforator flap vs comparator flaps (radial forearm free flap and anterolateral thigh flap). A Mantel–Haenszel fixed-effects model was used. Odds ratios are shown with 95% confidence intervals.
Fig. 7
Fig. 7
Methodological bias of included studies using the Risk Of Bias in Non-Randomized Studies – of Intervention (ROBINS-I) tool.
See this image and copyright information in PMC

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