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Extended Use of Chimeric Medial Sural Artery Perforator Flap for 3-Dimensional Defect Reconstruction

Lee, Che-Hsiung, MD*; Chang, Nai-Jen Tommy, MD*; Hsiao, Jo-Chun, MD*; Chu, Yu-Ying, MD*; Lin, Chih-Hung, MD; Kao, Huang-Kai, MD*; Lin, Cheng-Hung, MD*

doi: 10.1097/SAP.0000000000001697
Reconstructive Surgery
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Background 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.

Patients and Methods 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.

Results 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.

Conclusions 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.

From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan; and

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan.

Received September 7, 2018, and accepted for publication, after revision September 21, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Cheng-Hung Lin, MD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, 5, Fu-Shin Street, Kwei Shan, Taoyuan 333, Taiwan. E-mail: lukechlin@gmail.com.

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