J Reconstr Microsurg 2013; 29(07): 437-442
DOI: 10.1055/s-0033-1343959
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Applications of Medial Sural Perforator Free Flap for Head and Neck Reconstructions

Jong Woo Choi
1   Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
,
Soon Yuhl Nam
2   Department of Otolaryngology, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
,
Seung Ho Choi
2   Department of Otolaryngology, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
,
Jong Lyel Roh
2   Department of Otolaryngology, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
,
Sang Yoon Kim
2   Department of Otolaryngology, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
,
Joon Pio Hong
1   Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, Seoul, Korea
› Author Affiliations
Further Information

Publication History

16 November 2012

30 December 2012

Publication Date:
24 April 2013 (online)

Abstract

Oropharyngeal defects left after tumor resection are usually reconstructed with radial forearm or anterolateral thigh (ALT) perforator free flaps, but these flaps can be too thin or too thick. In this study, medial sural perforator free flaps with intermediate volumes were used for oropharyngeal reconstruction. Of the 243 patients with oropharyngeal cancer who underwent head and neck reconstruction between October 2006 and October 2011, the medial sural perforator free flap was used 20 times. The number and locations of the main sizable perforators, the dimensions and thickness of the flap, and the length of the pedicle were recorded. Satisfactory results were achieved in 18 patients. The flaps in the two remaining cases failed. The vertical locations of the main sizable medial sural perforators were 6 to 15 cm away from the popliteal crease. The medial sural perforator free flaps ranged from 4 to 10 mm in thickness. Medial sural perforator free flaps may be an alternative for medium-sized defects that cannot be properly reconstructed with radial forearm or ALT perforator free flaps because of their inappropriate flap volume.

 
  • References

  • 1 Ampil FL, Caldito G, Mills GM, Burton GV, Neupane P. Is chemoradiation as effective as surgery with postoperative radiotherapy for locally advanced (operable) head and neck cancer? A retrospective observational study. Radiat Med 2002; 20 (4) 217-219
  • 2 Bernier J, Cooper JS. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence?. Oncologist 2005; 10 (3) 215-224
  • 3 Soo KC, Tan EH, Wee J , et al. Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison. Br J Cancer 2005; 93 (3) 279-286
  • 4 Waldron J, Warde P, Irish J , et al. A dose escalation study of hyperfractionated accelerated radiation delivered with integrated neck surgery (HARDWINS) for the management of advanced head and neck cancer. Radiother Oncol 2008; 87 (2) 173-180
  • 5 Richey LM, Shores CG, George J , et al. The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg 2007; 136 (1) 98-103
  • 6 Dequanter D, Lothaire P. The role of salvage surgery in organ preservation strategies in advanced head and neck cancer. B-ENT 2008; 4 (2) 77-80
  • 7 Hall SF, Groome PA, Irish J, O'Sullivan B. Radiotherapy or surgery for head and neck squamous cell cancer: establishing the baseline for hypopharyngeal carcinoma?. Cancer 2009; 115 (24) 5711-5722
  • 8 Rieger JM, Zalmanowitz JG, Li SY , et al. Functional outcomes after surgical reconstruction of the base of tongue using the radial forearm free flap in patients with oropharyngeal carcinoma. Head Neck 2007; 29 (11) 1024-1032
  • 9 Bozec A, Poissonnet G, Chamorey E , et al. Free-flap head and neck reconstruction and quality of life: a 2-year prospective study. Laryngoscope 2008; 118 (5) 874-880
  • 10 Aki FE, Besteiro JM, Ferreira MC. Reconstruction of oropharyngeal defects utilizing a free radial forearm flap. Microsurgery 1994; 15 (1) 14-17
  • 11 Futran ND, Alsarraf R. Microvascular free-flap reconstruction in the head and neck. JAMA 2000; 284 (14) 1761-1763
  • 12 Germain MA, Legagneux J. [Vascular microsurgery and progress of free flap surgery]. Ann Chir 2001; 126 (10) 960-968
  • 13 Mao C, Yu GY, Peng X, Guo CB, Huang MX, Zhang Y. [A review of 545 consecutive free flap transfers for head and neck reconstruction in a new microsurgery unit]. Zhonghua Er Bi Yan Hou Ke Za Zhi 2003; 38 (1) 3-6
  • 14 Camaioni A, Loreti A, Damiani V, Bellioni M, Passali FM, Viti C. Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps. Acta Otorhinolaryngol Ital 2008; 28 (1) 7-12
  • 15 Wenig BL, Keller AJ. Microvascular free flap reconstruction for head and neck defects. Arch Otolaryngol Head Neck Surg 1989; 115 (9) 1118-1120
  • 16 Lew DH, Choi EC, Tark KC. Standardization of flap design for oropharyngeal reconstruction after cancer ablation surgery. Yonsei Med J 2003; 44 (6) 1078-1082
  • 17 Kim HH, Jeong JH, Seul JH, Cho BC. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg 2006; 117 (5) 1609-1618
  • 18 Mao C, Zhang L, Cui QJ, Peng X, Wang Y, Yu GY. [A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation]. Zhonghua Kou Qiang Yi Xue Za Zhi 2011; 46 (12) 742-746
  • 19 Kao HK, Chang KP, Chen YA, Wei FC, Cheng MH. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg 2010; 125 (4) 1135-1145
  • 20 Chang CC, Wong CH, Wei FC. Free-style free flap. Injury 2008; 39 (Suppl. 03) S57-S61
  • 21 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (6, Suppl): e419-e426
  • 22 Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, Navarro-Monzonís A, Soler-Nomdedeu S, Martínez-Soriano F. The medial sural artery perforator free flap. Plast Reconstr Surg 2001; 108 (6) 1609-1615 , discussion 1616–1617