Is the Medial Sural Artery Perforator Flap A New Workhorse Flap? A Systematic Review and Meta-Analysis

Background: The medial sural artery perforator (MSAP) flap offers thin, pliable tissue with a relatively long pedicle and low donor site morbidity. This study explores the characteristics and uses of the MSAP flap as well as postoperative outcomes and complications. Methods: A systematic literature review was performed using PubMed, Embase, and Cochrane CENTRAL to identify all cases of MSAP flap reconstruction. Descriptive and meta-analyses were performed on pooled outcomes. Multivariate logistic regression identified factors associated with increased complication rates. Results: Thirty-five studies encompassing 526 MSAP flaps were included for analysis. The most common reasons for surgery were oncologic (47.6%) and traumatic injuries (31.8%). The oral cavity was the most common recipient location (45.5%). Average flap dimensions were 6.0 ± 2.3cm by 9.8 ± 3.6cm with an average pedicle length of 10.1 ± 6.6cm. Meta-analysis revealed an overall complication rate of 14.3% (Q value=22.16, p=0.877, I2= -39.9). Use of chimeric MSAP flaps was associated with significantly higher rates of complications (OR=3.92, p=0.039, 95% CI 1.10-13.89). The majority of flap donor sites were closed primarily (68%) versus 32% that were covered with a split-thickness skin graft (STSG). A flap width greater than 5.75cm had an OR=5.3 (95% CI, 1.3-21.8; p=0.014) of having a donor site complication if closed primarily. Conclusions: The MSAP flap offers thin, pliable tissue with a relatively long pedicle and has minimal donor site morbidity when the donor site is managed appropriately. As such, it should be considered a workhorse flap for both head and neck and extremity reconstruction. This manuscript has been accepted as an abstract to the American Society of Plastic Surgeons' Annual Meeting: Plastic Surgery The Meeting 2018 in Chicago, Illinois during the Reconstruction 1A Session on September 30th, 2018. Disclosure: The authors have no financial interest to declare in relation to the content of this work. Corresponding author: David A. Daar, MD, MBA, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, 305 East 33rd St. Lower Level, New York, NY 10016, Daard01@nyumc.org, 847.276.1310 ©2018American Society of Plastic Surgeons

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