Lee Che-Hsiung, Chang Nai-Jen Tommy, Hsiao Jo-Chun, Chu Yu-Ying, Lin Chih-Hung, Kao Huang-Kai, Lin Cheng-Hung
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan.
Ann Plast Surg. 2019 Jan;82(1S Suppl 1):S86-S94. doi: 10.1097/SAP.0000000000001697.
The medial sural artery perforator (MSAP) flap has become increasingly popular because it is thin and pliable for small to moderate defect soft tissue reconstruction. Furthermore, chimeric MSAP flap, which includes a skin paddle and a separated piece of medial gastrocnemius muscle, allowed more freedom for flap insetting, especially in 3-dimensional defect reconstruction. Here we describe our experience regarding this clinical application.
From 2007 to 2016, 14 male patients (average age, 46.9 ± 14.4 years) who received either a free or pedicled chimeric MSAP flap were included. Of these 14 patients, 7 received this flap for reconstruction in the head and neck, 2 in the upper extremities, and 5 in the lower extremities. Demographic data were collected and analyzed, and a literature review was performed.
Ten patients received free chimeric MSAP flap, and 4 received the pedicled type. Thirteen of the 14 flaps (92.6%) survived, and 1 failed 2 days later owing to venous insufficiency. Venous congestion-related partial loss occurred in another case.
The chimeric MSAP flap is a good alternative for deep space obliteration or reconstruction of adjacent but separate defects in both free and pedicled flap design. Donor site morbidity is limited. However, the perforator needs to be mobilized carefully to prevent postoperative venous compromise.
腓肠内侧动脉穿支（MSAP）皮瓣因其薄且柔韧，适用于中小面积缺损的软组织重建，越来越受到欢迎。此外，包含皮岛和单独腓肠内侧肌块的嵌合型MSAP皮瓣，在皮瓣植入时具有更大的灵活性，尤其适用于三维缺损的重建。在此，我们描述我们在该临床应用方面的经验。
纳入2007年至2016年期间接受游离或带蒂嵌合型MSAP皮瓣移植的14例男性患者（平均年龄46.9±14.4岁）。这14例患者中，7例接受该皮瓣用于头颈部重建，2例用于上肢，5例用于下肢。收集并分析人口统计学数据，并进行文献回顾。
10例患者接受游离嵌合型MSAP皮瓣，4例接受带蒂型。14例皮瓣中有13例（92.6%）存活，1例术后2天因静脉回流障碍失败。另1例出现与静脉淤血相关的部分坏死。
嵌合型MSAP皮瓣无论是游离皮瓣还是带蒂皮瓣设计，都是深部组织填充或相邻但分离缺损重建的良好选择。供区并发症有限。然而，穿支血管需仔细游离，以防止术后静脉回流障碍。
