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Reconstruction in head and neck surgical oncology
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Kishan Ubayasiri, Andrew Foreman
Whilst reconstructive microsurgery is used for the majority of oral cavity soft tissue defects, other pedicled options exist, such as the buccinator myomucosal flap, naso and submental island flap or even melolabial flaps. These can be limited by length of pedicle, previous radiotherapy fields and size of tissue available. All of these can be overcome by the use of free flaps. The most commonly used free flaps for oral cavity soft tissue reconstruction are the radial forearm free flap (RFFF) and the anterolateral thigh (ALT) flap. Less commonly used is the medial sural artery perforator (MSAP) flap (see Table 16.3).
Complications of Reconstructive Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Deepak Narayan, Joseph H. Shin
The gastrocnemius is conveniently divided into two heads, each with its own blood supply. This muscle is particularly robust and is useful for covering defects around the knee joint or tibia in the case of infections, exposed hardware following fracture fixation, or possibly in tumor resections. Contour donor defects can result if the muscle is used with a skin paddle. Therefore, the muscle is usually transferred without the overlying skin and is often covered by a split-thickness skin graft. Damage to surrounding structures such as to the tibial and peroneal nerves can result during dissection of the popliteal fossa. Sural artery occlusion due to kinking of the pedicle may compromise the vascularity of the flap; a preoperative angiogram can identify this arterial anatomy and may help prevent this mishap. Lower-extremity deep vein thrombosis is a relative contraindication to the use of this flap. To preserve plantar flexion, the medial or lateral gastrocnemius muscle flap should not be used if the opposite head of the gastrocnemius and the soleus muscles are not functional.
Soft-Tissue Repair for Proximal and Middle Third Problems
Published in Armstrong Milton B., Lower extremity Trauma, 2006
Kreithen Joshua, Woodberry Kerri, O Seung-Jun
The sural artery flap is a fasciocutaneous flap located between the popliteal fossa and the midline raphe between the medial and lateral heads of the gastrocnemius muscle. The maximal area of tissue that can be transferred is approximately 20 X 12 cm2. The standard flap is a U-shaped flap with the apex in the midposterior leg centered over the midline raphe between the heads of the gastrocnemius. After elevation, the flap will reach defects in the knee, popliteal fossa, and the upper third of the leg. The flap can also be designed as an island flap, reversed flap, or for use in microvascular transplantation.
Free neurosensory flap based on the accompanying vessels of lateral sural cutaneous nerve: anatomic study and preliminary clinical applications
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Weichao Yang, Gen Wen, Feng Zhang, William C. Lineaweaver, Chunyang Wang, Kyler Jones, Yimin Chai
The anatomy of the SLSA has been described in a few studies. Li et al. [7] dissected 20 legs and found that the SLSA existed in all specimens and that in 85% of cases, it originated from the popliteal artery. The artery descended along the LSCN and the posterolateral aspect of the leg with two venae comitantes. Wolff et al. [9] reported that the SLSA was present in 85.5% of their 42 specimens. The artery originated from the popliteal artery in 69% and from the lateral sural artery in 31%. An SLSA with a diameter > 1 mm was only found in 69.4% of the legs. Of the specimens, 59.5% of the SLSAs had two vena comitantes, while 40.5% had only one. In this study, the SLSA was found present in all the cadaveric dissections and clinical cases. More importantly, it was observed there was an intimate relationship or ‘dance’ between the SLSA and LSCN; the SLSA adhered to the LSCN and ramified along with the LSCN, both when the LSCN gave off PCNs and when it gave off terminals. This finding complements Masquelet’s anatomical study, further describing the vascular basis of neurocutaneous flaps [14].
An early complication in the donor site of the medial sural artery perforator flap: necrosis of the medial head of gastrocnemius
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Hui-Ju Tsou, Chih-Peng Tu, Yu-Fan Chen, Wen-Teng Yao
Dusseldorp et al. recently defined a new classification of the intra-muscular branching pattern of the medial sural artery [10]. There are four types: type I of a single branch, type IIA of dual branching with high take-off point above the tibial plateau, type IIB of dual branching with low take-off point below the tibial plateau, and type III of three or more branches. In type IIA, one of the dual-branch that is not dissected during flap harvest could be preserved due to the high take-off point. However, in type IIB, due to the low take-off point, the other branch that is not dissected would be sacrificed as well if the pedicle is dissected up to the origin of the medial sural artery. In the latter case, as in type I branching pattern, once the pedicle is elevated, the proximal blood supply of the medial gastrocnemius muscle is compromised. Therefore, the remaining blood supply from adjacent angiosome becomes extraordinarily important.
Surgical delay in reverse sural artery flap prevents congestion of the flap: a case report of the stepwise delay method
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Yuta Izawa, Hiroko Murakami, Tetsuya Shirakawa, Kentaro Futamura, Masayuki Hasegawa, Yoshihiko Tsuchida
Seven days after flap elevation, surgery was performed using a sciatic nerve block. The patency of the superficial sural vein was good and the patency of the lesser saphenous vein was weak. The superficial sural artery, lesser saphenous vein, and medial sural cutaneous nerve were dissected. The remaining superficial sural vein was clamped with a vascular clip, and the wound was closed. After six hours, the flap was clearly congested. In the ward, the clip in the superficial sural vein was removed. Immediately after removing the clip, the color tone of the flap normalized (Figure 6).