The chimeric medial sural artery perforator free flap for individualized and three-dimensional reconstruction in hemiglossectomy defects.

Abstract

The objective of this study was to describe the four types of Chimeric Medial Sural Artery Perforator Free Flap (CMSAPFF) in restoring the hemiglossectomy defect. This is a prospective study of patients who underwent hemiglossectomy reconstruction using CMSAPFF between February 2022 and July 2023. Special consideration was given to the distribution of the medial sural artery (MSA) perforators, the design of the chimeric flap, the survival rate, complications and functional outcomes. Flap survival was 94.6%. The CMSAPFF was harvested as the skin paddle and the muscle paddle, with four designs in all flaps. Eighteen CMSAPFFs were reported in this study: Type I (n = 3), Type II (n = 7), Type III (n = 6), and Type IV (n = 2). The number of MSAPs ranged from 1 to 4 (median: 2.0). The MSAP was mostly located between 6 and 13 cm distal to popliteal crease (median: 9.7cm). The skin was used to 3-dimensional reconstruction of the hemiglossectomy defect, whereas the muscle paddle was used either to reconstruct the floor of the mouth (n = 13) or to support the skin paddle (n = 5). The CMSAPFF offers flexibility during flap inset and provides bulk to three-dimensional defect. Furthermore, it provides a good watertight sealing in the floor of the mouth.