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Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity

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Abstract

Objective

Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life.

Methods

All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed.

Results

The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05).

Conclusion

The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF.

Clinical relevance

The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.

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Data availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

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Author notes

  1. Abdo Ahmed Saleh Mohamed and Lianxi Mai have contributed equally to this work.

Authors and Affiliations

  1. Department of Oral & Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, 510120, China

    Abdo Ahmed Saleh Mohamed, Lianxi Mai, Song Fan, Shuang Wang, Zhaoyu Lin & Chaobin Pan

  2. Department of Oral Implant, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Mubarak Ahmed Mashrah

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Contributions

Conceptualization, Abdo Ahmed Saleh Mohamed, Lianxi Mai, and Zhauyu Lin; Data curation, Lianxi Mai, Zhauyu Lin, and Chaobin Pan; Formal analysis, Abdo Ahmed Saleh Mohamed, and Lianxi Mai; Investigation, Abdo Ahmed Saleh Mohamed, Shuang Wang and Lianxi Mai; Methodology, Abdo Ahmed Saleh Mohamed, Zhauyu Lin,, and Mubarak Ahmed Mashrah; Project administration Abdo Ahmed Saleh Ahmed, Fan Song, and Chaobin Pan; Resources, Abdo Ahmed Saleh Mohamed, Shuang Wang and Lianxi Mia; Software, Abdo Ahmed Saleh Mohamed, Supervision, Chaobin Pan and Mubarak Ahmed Mashrah, Validation, Abdo Ahmed Saleh Mohamed, Mai Lianxi, Shuang Wang, Zhauyu Lin; Visualization, Abdo Ahmed Saleh Mohamed, Mubarak Ahmed Mashrah, Zhauyu Lin and Lianxi Mai; Writing – original draft, Abdo Ahmed Saleh Mohamed, Lianxi Mai, and Mubarak Ahmed Mashrah; Writing – review and editing, Abdo Ahmed Saleh Mohamed, Fan Song, Mubarak Ahmed Mashrah, and Chaobin Pan. All authors have read and agreed to the published version of the manuscript. The author(s) read and approved the final manuscript.

Corresponding authors

Correspondence to Zhaoyu Lin or Chaobin Pan.

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All participants gave informed consent to participate. This study was conducted with the guidelines of the Helsinki Declaration and received approval from the Ethics committee of the Memorial Hospital of Sun Yat-sen University (Ethical Approval Number: SYSKY-2023-027-01.

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The informed consent was obtained, the authors are attesting that participants were aware of the study purpose, risks and benefits.

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Mohamed, A.A.S., Mai, L., Mashrah, M.A. et al. Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity. Clin Oral Invest 28, 269 (2024). https://doi.org/10.1007/s00784-024-05618-1

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