Medial sural artery perforator flap in head & neck reconstruction

This review focuses on the recent advancements in the application of the medial sural artery perforator (MSAP) flap for head and neck reconstruction. It highlights key anatomical findings, surgical techniques, comparative outcomes, and future perspectives from the last 1-3 years of research.

The MSAP flap has emerged as a reliable option for head and neck reconstruction due to its thin, pliable nature and minimal donor-site morbidity. Recent anatomical studies have refined understanding of its vascular consistency, with perforators located 8-12 cm distal to the popliteal crease and pedicle lengths averaging 10.1 cm. Functional outcomes demonstrate superiority over bulkier alternatives such as the anterolateral thigh flap, particularly in intraoral reconstructions, while donor-site morbidity remains significantly lower than that of the radial forearm free flap.

The MSAP flap provides an optimal balance of form and function for complex head and neck reconstructions. Its consistent anatomy and favorable postoperative outcomes underscore its growing role in modern reconstructive surgery. Further multicenter trials are essential to establish standardized protocols and enhance outcomes.