The use of medial sural perforant flap in the treatment of locally advanced oropharyngeal cancer

The surgical stage of radical treatment of advanced oropharyngeal cancer is often associated with combined resections,
which entail the formation of anatomically and functionally complex defects. The elimination of complex oropharyngeal defects requires a high level of reconstructive surgery in an institution that treats this group of patients. Most often, a radial flap is used to eliminate defects in the oral cavity and oropharynx, it has proven itself well in terms of high plasticity, but its use is associated with severe damage to the donor area, which is considered unacceptable in modern reconstructive surgery. Thus, the choice of the optimal plastic material for the replacement of complex oropharyngeal defects is an urgent oncological problem.
Goal: а retrospective analysis of the results of the elimination of combined oropharyngeal defects using a free revascularized medial surgical autograft in oncological practice.
Materials and methods. A retrospective study involved 15 patients (5 men and 11 women) with metamorphosed cancers of the oral cavity, tongue and oropharynx who received surgical treatment at the Saint Petersburg State Medical University City Clinical Oncology Dispensary (Saint Petersburg). The average age of the patients was 53 years. In all cases, a medial sural perforator flap was used for the purpose of simultaneous microsurgical removal of a combined oropharyngeal defect.
Research results. The medial sural flap was successfully used in all 15 cases. One case required revision of the postoperative wound and vascular anastomosis in the early postoperative period (hematoma). In one case, we encountered partial necrosis of the skin portion of the graft in the early postoperative period.
Conclusions. The experience of using the medial sural perforator flap in the reconstruction of oropharyngeal defects confirms its effectiveness. The main criteria for choosing an autologous tissue complex for oropharygeal reconstruction are comparable to those of a radial flap (elasticity, consistency of anatomy, length and diameter of vessels), however, minimal donor damage in the form of a linear scar on the back of the shin gives this transplant an undeniable advantage in terms of the patient’s quality of life.

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