Medial Sural Artery Perforator Flap Aided by Ultrasonic Perforator Localization for Reconstruction After Oral Carcinoma Resection

To evaluate the application of the medial sural artery perforator flap (MSAPF) aided by preoperative ultrasonic perforator localization for postsurgical reconstruction of oral carcinoma.From November 2013 to August 2014, 25 patients with oral carcinoma underwent postsurgical reconstruction after oral carcinoma resection using MSAPFs. To explore and locate the perforators, preoperative vascular ultrasound localization was used to find the MSAPs. The number and location of the perforators, length of the vascular pedicle, and thickness of the MSAPF were measured. Thirty-eight patients who underwent reconstruction with a radial forearm flap (RFF) and 21 patients who underwent reconstruction with an anterolateral thigh flap (ALTF) were selected for comparison.The number of MSAPs ranged from 1 to 4, and 52 perforators were found accurately using preoperative ultrasonic localization (92.86%). The distance from the perforator to the popliteal crease ranged from 6.2 to 17.1 cm (10.70 ± 2.31 cm); the distance from the perforator to the midline of the back of the calf ranged from 0.1 to 3.5 cm (1.83 ± 0.81 cm); and the pedicle length ranged from 6.8 to 12.5 cm (10.14 ± 1.51 cm). Compared with the RFF, and ALTF, the thickness, postoperative oral sensation, and function of the MSAPF were similar to those of the RFF but better than those of the ALTF. In appearance and function of the donor site, the MSAPF was similar to the ALTF, but better than the RFF.The MSAPF is a good alternative for postsurgical reconstruction of oral carcinoma because of its anatomic structural stability, suitable thickness, minimal donor-site scar, and ideal functional recovery after surgery. Preoperative vascular ultrasonic localization is a feasible and advantageous method for preoperative mapping of the MSAP because of its high accuracy.