ALNafisee, Daniah

ABSTRACT Background Medial sural artery perforator (MSAP) flaps are favored in head and neck reconstruction for skin paddle pliability, pedicle length, and low donor site morbidity. We sought to characterize MSA vascular branching patterns based on the Dusseldorp et al. classification system using pre‐operative lower extremity computed tomography angiogram (CTA). Methods We conducted a retrospective review of 153 scans from 78 patients who underwent CTA prior to head and neck reconstruction at our institution. Primary data points included MSA branching pattern, branch dominance, and vessel depth. Results The type IIa branching type was most prevalent and the MSA lateral branch most frequently dominant, and they were significantly related to one another. There was no significant difference in depth between branching patterns. Conclusions Lower extremity CTA provides valuable insight to vascular anatomy for MSAP flap harvest. The type IIa and IIb types may be associated with lateral and medial MSA dominance, respectively.

An extended orbital exenteration defect in a male in his mid-80s was successfully reconstructed with a medial sural artery perforator flap. To our knowledge, this flap has not been described in the literature for such defects until now. While it may require meticulous intramuscular perforator dissection, it provides several advantages; it is thin, pliable, has a long pedicle of large calibre facilitating microanastomosis and provides adequate coverage where the amount of chimeric muscle can easily be tailored to the defect’s surface area and volume. In addition, its robust vascular supply can withstand volume changes post radiation therapy. Two years after surgery, the patient has healed well with an excellent functional outcome.