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J Reconstr Microsurg 2021; 37(05): 445-452
DOI: 10.1055/s-0040-1718551
Original Article

A Head-to-Head Comparison of the Medial Sural Artery Perforator versus Radial Forearm Flap for Tongue Reconstruction

Marcus J.M. Ng
1   Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Cindy S.L. Goh 
2   Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Ngian Chye Tan
3   SingHealth Duke-NUS Head and Neck Center, SingHealth, Singapore
,
David H. Song
4   Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
,
Adrian S.H. Ooi 
2   Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
3   SingHealth Duke-NUS Head and Neck Center, SingHealth, Singapore
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Abstract

Background For tongue reconstruction, the radial forearm flap (RFF) is commonly used. In the last decade, the medial sural artery perforator (MSAP) flap has been successfully used with reportedly superior donor-site outcomes. Our study is the first to compare the RFF and MSAP for reconstruction of partial glossectomy defects (<50% of tongue).

Methods We conducted a retrospective review of 20 patients with partial glossectomy defects reconstructed at a tertiary referral center. Patient demographics, perioperative data, and postoperative complications were analyzed. Objective measures of speech, swallowing, and subjective patient satisfaction with their donor site were recorded.

Results Ten RFF and MSAP were each used, with a mean partial glossectomy defect size of 40.5 and 43.5%, respectively. The MSAP was significantly thicker (7.8 vs. 4.3 mm, p < 0.05) with a longer harvest time (122.5 vs. 75.0 minutes, p < 0.05). There were no cases of free flap failure. Donor-site healing times were comparable, but the MSAP group experienced significantly less donor-site complications (n = 1 vs. n = 7, p < 0.05). Functional outcomes were comparable with 13 patients achieving normal speech and diet after 3 months (MSAP = 6 vs. RFF = 7, p = 1.00). All patients were satisfied with their donor-site outcome with the MSAP group having a marginally higher score.

Conclusion Both flaps are good options for partial glossectomy reconstruction. Though more challenging to harvest, the MSAP gives comparable functional results and has become our first reconstructive option given its superior donor-site outcomes.

Keywords

medial sural artery perforator flap - radial forearm flap - tongue reconstruction - free tissue transfer - head and neck reconstruction

Note

This study was presented at the Plastic Aesthetic Surgery Meeting 2018 in Singapore.




Publication History

Received: 15 June 2020

Accepted: 02 September 2020

Article published online:
08 October 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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