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CC BY 4.0 · Surg J (N Y) 2023; 09(03): e82-e88
DOI: 10.1055/s-0043-1770956
Original Article

Reconstruction of Upper and Lower Limb Defects with Medial Sural Artery Perforator Flaps: Is Aesthetics Worth the Effort? A Retrospective Analysis

Ziyad Alharbi
1   Plastic Surgery and Burn Unit, Dr. Solaiman Fakeeh Hospital, Jeddah, Saudi Arabia
2   Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
,
Sarah Qari 
1   Plastic Surgery and Burn Unit, Dr. Solaiman Fakeeh Hospital, Jeddah, Saudi Arabia
,
Faris Almarzouqi
3   Department of Plastic Surgery, International Medical Center, Jeddah, Saudi Arabia
,
Khalid Khatib
4   Department of Plastic Surgery, Saudi German Hospital, Jeddah, Saudi Arabia
,
Savas Tsolakidis
5   Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, Austrian Cluster of Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Trauma, RWTH Aachen University Hospital, Aachen, Germany
,
Anas Fathuldeen
6   Department of Surgery, Plastic Surgery College of Medicine, Hail University, Hail, Saudi Arabia
,
Gerrit Grieb
7   Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
8   Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Berlin, Germany
,
Hans-Oliver Rennekampff
9   Department of Plastic and Aesthetic Surgery, Burn Surgery, Rhein-Maas Klinikum, Würselen, Germany
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Abstract

Background One of the most essential goals in managing complex limb defects is obtaining adequate soft tissue coverage with excellent functional and aesthetic outcomes. Free perforator skin flaps represent an optimal option for such defects. Therefore, our intention was to reconstruct these kinds of defects with thin fasciocutaneous flaps without the need for debulking. Herein, we define the legitimate use of the medial sural artery perforator (MSAP) flaps for small-moderate size defect coverage of the hand and foot.

Patients and Methods Seven patients received MSAP flaps for reconstruction of different hand and foot defects, of which the majority were males (4/7). Age, sex, flap size, location, number of perforators, recipient vessel, type of anastomosis, technique of donor site closure, and postoperative morbidity were recorded. Patients' age ranged from 48 to 84 years.

Results Single-stage debridement followed by reconstruction was performed. Flap sizes ranged from 6 to 18 cm in length and 4 to 10 cm in width. The pedicles of 6 flaps were anastomosed to the tibial artery system (three posterior tibial artery, three dorsalis pedis artery) and one to the ulnar artery.

Conclusion MSAP flap can be a versatile option for single-stage reconstruction of small-moderate size defects of the extremities, where thin, soft tissue envelope is required. This flap has lower donor site morbidity, more tedious elevation process, and has a good reconstructive and aesthetic result without the need for debulking in the future.

Keywords

free flaps - medial sural artery perforator flaps - fasciocutaneous flaps - reconstruction - hand deformity - foot deformity - extremity

Authors' Contributions

The manuscript draft was authored by K.K., S.Q., and F.A. The surgical procedures were performed by Z.A. and H-O.R., K.K., A.F., S.T. and G.G. provided patient care throughout the hospital stay. The final version of the manuscript was reviewed by Z.A and H-O.R. before undergoing corrections and receiving approval from all authors.


Consent for Publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.




Publication History

Received: 24 December 2022

Accepted: 26 May 2023

Article published online:
10 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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