ABSTRACT
Microvascular couplers have a record of efficiency and efficacy. They have been used in anastomoses in the head and neck in Sunderland since November 2013, where we have investigated the time taken for anastomosis, patency, and cost. We also completed a national survey of the use of couplers in the United Kingdom, in which we recorded the time of anastomosis. The mean (range) time was 4minutes (2minutes 40seconds - 4minutes 10seconds). One flap partially failed. This shows that couplers can save time, they have successful outcomes, and the technique is quick and easy to learn.
Subject(s)
Anastomosis, Surgical/instrumentation , Learning Curve , Microsurgery/education , Microsurgery/instrumentation , Practice Patterns, Physicians'/statistics & numerical data , Surgical Flaps , England , Equipment Design , Humans , Prospective StudiesABSTRACT
BACKGROUND: The medial sural artery perforator (MSAP) flap is a fasciocutaneous flap that is gaining popularity for intra-oral reconstructions. The aim of this two-centre review was to evaluate the use of the MSAP flap in intra-oral reconstructions and report our experiences. METHODS: Data were collected prospectively on 35 consecutive intra-oral reconstructions using the free MSAP flap. Patient details and intraoperative flap details were recorded. RESULTS: Thirty-five patients underwent intra-oral reconstruction with a free MSAP flap (26 males and nine females). The average flap dimensions were a length of 8.03 cm, a width of 5.0 cm and a thickness of 7.1 mm. Twenty-two flaps had two perforators, and the average pedicle length was 11.1 cm. There were no flap losses. Ninety-one per cent of donor sites were closed primarily. There were two minor complications related to donor-site wound dehiscence, which required delayed skin grafting. The overall complication rate was 5.7%. CONCLUSIONS: The MSAP flap is a good choice for intra-oral reconstruction. It has reliable anatomy and provides thin, pliable skin with a long pedicle. In addition, donor morbidity is low as the donor site can be closed directly in most cases. It is currently our flap of choice for small intra-oral soft tissue defects.
Subject(s)
Carcinoma, Squamous Cell/surgery , Mouth Neoplasms/surgery , Oral Surgical Procedures/methods , Perforator Flap/transplantation , Adult , Aged , Aged, 80 and over , Arteries , Female , Humans , Leg/blood supply , Male , Middle Aged , Muscle, Skeletal/blood supply , Perforator Flap/blood supply , Photography , Prospective Studies , Tissue and Organ Harvesting/methodsABSTRACT
The medial sural artery perforator (MSAP) flap has been well-described but has yet to find popularity in the United Kingdom. We describe our early experience of its use in 6 patients and our simplified method of marking up. Flaps ranged in size from 7×4cm to 12×5.5cm, and were thin (between 4 and 10mm). Pedicles were between 11 and 14cm long, arterial diameters were 1-2mm, and venous calibres were 2-6mm. We raised 4 flaps without the use of a tourniquet and found it helpful. Straightening the leg as the popliteal fossa was approached also eased dissection. There can be 2 separate pedicles. The donor site was closed primarily in 5 cases and all flaps survived. The MSAP is easier to do than the radial artery forearm free flap (RAFFF) and is a reliable alternative with low morbidity.
Subject(s)
Perforator Flap/transplantation , Plastic Surgery Procedures/methods , Surgical Flaps/transplantation , Tibial Arteries/transplantation , Adult , Aged , Carcinoma, Squamous Cell/surgery , Female , Forearm/surgery , Graft Survival , Humans , Male , Middle Aged , Perforator Flap/blood supply , Radius/surgery , Tongue Neoplasms/surgery , Transplant Donor Site/surgeryABSTRACT
We present a simple way of orientating large specimens being sent to the laboratory for histopathological examination by supplementing the pinning of the specimen on a cork board with Polaroid photographs of the specimen and numbered tags.
