Technical refinements of the free medial sural artery perforator (MSAP) flap in reconstruction of multifaceted ankle soft tissue defects |
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| Affiliation: | 1. St. Andrew’s Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, CM17ET, UK;2. STAAR, St. Andrews Anglia Ruskin Research Group, UK;1. Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA;2. Department of Orthopaedics, Foot and Ankle Surgery, University of Sao Paulo (USP), St. Ovidio Pires de Campos 333, Sao Paulo, SP, Brazil;1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA;2. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84132, USA;3. Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland;4. Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA;5. Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA;1. Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium;2. Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium;3. Department of Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium;4. Department of Development and Regeneration, KU Leuven, Leuven, Belgium;5. Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium;6. Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium;1. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan;2. Department of Orthopedic Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan;3. Devision of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei, Taiwan;1. Sapienza Università di Roma, Policlinico Umberto I, Department of Surgery “P. Valdoni”, Unit of Plastic Reconstructive and Aesthetic Surgery, Rome, Italy;2. Department of Oncologic and Reconstructive Breast Surgery, “Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest”, Italy;3. Sapienza Università di Roma, Policlinico Umberto I, Department of Physical Medicine and Rehabilitation, Rome, Italy;4. Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan;5. Policlinico Luigi Di Liegro, Via dei Badoer, Rome, Italy;6. Department of Plastic Surgery, Clinica Mater Dei, Rome, Italy |
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| Abstract: | BackgroundPeri-ankle defects are difficult to reconstruct due to sharp contours, thin skin, aesthetic value, function and footwear impact. The medial sural artery perforator flap (MSAP) is increasing in popularity as a thin and pliable flap. This study aims to demonstrate its versatility in reconstructing defects around the ankle area and our approach to insetting these flaps in difficult areas around the ankle without the need for subsequent flap revisions.MethodsA retrospective review of the senior author’s series of peri-ankle reconstructions using the MSAP flap was undertaken.ResultsBetween 2011–2015, 15 patients underwent peri-ankle reconstruction with the MSAP flap. There were 4 dorsal foot, 4 medial malleolar, 4 lateral malleolar, and 3 tendo-achilles defects. All flaps in this series survived. There was one episode of partial flap necrosis in one patient and no incidences of donor site dehiscence. All patients returned to full ambulation and none required subsequent flap revision.ConclusionsThe MSAP flap offers the benefits of a fasciocutaneous flap, whilst providing a thin, pliable, single stage and robust reconstruction for peri-ankle defects, with a cosmetically ideal donor site. |
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| Keywords: | Lower limb Ankle defects Fasciocutaneous flap MSAP flap Medial sural artery perforator flap Ankle reconstruction Lower limb reconstruction Lower limb trauma Free flap Microsurgery |
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