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Calf donor sites offer optimally thin tissue for intraoral reconstruction

Calf donor sites offer significantly thinner tissue perforator flaps for use in intraoral reconstruction compared with conventional thigh donor sites, according to study results published in Plastic and Reconstructive Surgery.

As the anterolateral thigh (ALT) donor sites are often too thick for intraoral reconstruction, and the radial forearm flap is a poor donor site despite thin, quality tissue, Alexandra R. Molina, MD(Cantab), FRCS(Plast), and colleagues designed a two-part study to assess use of the medial sural artery perforator (MSAP) flap, the sural artery and the lateral sural artery from the calf.

For the first part of the study, the researchers analyzed 50 consecutive limb CT angiograms from 20 female and 30 male patients. They compared the tissue thickness of the ALT donor site with that of the medial calf region. The mean tissue thickness in the thigh was 17 mm while the mean thickness for the calf tissue was 8.4 mm.

For the second part, the researchers analyzed the outcomes of 20 patients who underwent calf perforator flaps reconstruction for intraoral defects. This included 17 males and three females with a mean age of 55 years. The patients were all undergoing reconstruction following tumor resection, comprising 19 squamous cell carcinomas and one clear cell carcinoma. The recipient sites were floor of mouth (n = 10), tongue (n = 7), buccal mucosa (n = 2) and hard palate (n = 1).

In total, there were 17 true MSAP flaps raised along with two sural artery and one soleal artery perforator flaps. The flap skin paddle size ranged from 5 cm × 4 cm to 12 cm × 6 cm.

There were only two postoperative complications. One patient was required to return to surgery for wound dehiscence and late hematoma, though no revisions to the anastomoses were indicated. The other case was an infection around the intraoral suture line, which was treated with IV antibiotics.

“Calf perforator flaps produce reliable soft tissue coverage for small-to-medium size intraoral defects and would advocate that the calf be considered the first line of donor site in these cases,” the authors wrote. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.