Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The medial sural artery perforator (MSAP) free flap is an excellent option for soft tissue defects of the head and neck. Minimal donor site morbidity is often cited as one of the main advantages of MSAP flaps, however few studies have examined functional outcomes after MSAP flap using validated patient-reported outcome measures.
Methods: Demographic and surgery specific information of patients undergoing MSAP flap for head and neck reconstruction was collected from 2022 until 2024 at a single institution. To assess morbidity, the lower extremity functional scale (LEFS) was administered at post-operative follow up visits. This validated patient reported outcome metric assesses patients’ abilities to perform everyday activities that require use of the lower limb and is scored out of 80.
Results: Twenty-one consecutive patients underwent successful MSAP free tissue transfer for head and neck defects. Among these patients, free flap size varied between 5x2cm to 12x6cm. Two patients required a split thickness skin graft for donor site closure (9.5%), with all other donor sites being closed primarily (90.5%). In the immediate post-operative period (<1 month after surgery) the average LEFS score was 59.6 (95% CI, 46.5 – 72.6). At 1 to 3 months the average LEFS score was 63.0 (95% CI, 56.0 – 70.0), at 3 to 6 months the average LEFS score was 75.0 (95% CI, 70.0 – 80.0), and over 6 months after surgery the average LEFS score was 79.8 (95% CI, 79.4 – 80.0).
Conclusion: The MSAP flap is a free tissue reconstructive option with extremely minimal donor site morbidity. Based on the LEFS, patients did not have any perceptible donor site morbidity by one year after surgery.