Reconstruction of Head and Neck Defects Using Medial Sural Artery Perforator Free Flap

Aim: To study the use of medial sural artery perforator (MSAP) free flap in head and neck reconstruction. Material and method: This was a prospective study. The patients with cancers of head and neck underwent excision of tumor along with neck dissection, and MSAP free flap was used for reconstruction. Results: The free MSAP flaps were used in 30 patients to reconstruct head and neck soft tissue defects. There were sixteen male and six female patients with the median age of 40 years. The most common site of tumor resection was the tongue (14 cases), followed by buccal mucosa (12 cases), neck skin(2 cases), skin over parotid(1 case) and lip(1 case). Average flap size was 56 cm². Thickness of the flap ranged from 4 to 8 mm. The length of the vascular pedicle ranged from 8 to 14 cm (12 cm mean) which provides sufficient length during vessel anastomosis. Arterial diameter ranged from 1.0 to 1.5 mm(Average − 1.25 mm) and venous diameter of both veins in pedicle ranged from 1.5 to 2.5 mm(Average − 2 mm) in size. Most flaps were based on two perforators. Primary closure was attained in 11 cases whereas 19 patients required split thickness skin graft(STSG). The average flap harvesting time was 45 min. Flap was failed in two cases. Conclusion: MSAP is good alternative to FRAFF in the reconstruction of defect after resection of head and neck cancer.