American Association of Plastic Surgeons

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The Versatile Free Medial Sural Artery Perforator (MSAP) Flap: An Institutional Experience for Reconstruction from Head to Toe
Gloria R. Sue, MD1, Ming-Huei Cheng, MD2.
1Stanford University, Stanford, CA, USA, 2Chang Gung Memorial Hospital, Taipei, Taiwan.

PURPOSE: The medial sural artery perforator (MSAP) flap was first described in 2001 and has since become increasingly used for soft tissue reconstruction. Here we report the single largest institutional experience with the MSAP flap.
METHODS: A retrospective review was performed on consecutive patients undergoing reconstruction with the MSAP flap at Chang Gung Memorial Hospital from 2006 through 2017. Patient demographic factors including age, gender, and indication for reconstruction were assessed. Post-operative complications were the primary outcome measure.
RESULTS: We identified 246 patients that underwent a total of 248 MSAP flap reconstructions during the study period. The average age was 47.5 years and 85.4% of the cohort was male. Of the 248 flaps, 170 were used for reconstruction of the head and neck, 48 for upper extremity reconstruction, and 30 for lower extremity reconstruction. 31 (12.5%) of the flaps developed arterial occlusion, venous insufficiency, or a hematoma post-operatively requiring re-operation. Of these flaps, 19 were successfully salvaged, yielding an overall flap failure rate of 4.8%. Minor complications included the need for flap debridement (7.3%) and donor site debridement (3.2%). The upper and lower extremity flap recipient sites were more likely to develop wound complications compared to the head and neck (P = 0.003).
CONCLUSION: 248 free MSAP flap reconstructions were performed in this large single institution study with a failure rate of less than 5%. The MSAP flap can be used in a versatile fashion to reconstruct defects of the head and neck, upper extremity, and lower extremity.


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