Background: For a small to medium-sized defect in the head and neck region after cancer ablation, the free radial forearm flap is commonly used. More recently, the free medial sural artery perforator flap has been used as an alternative. The authors investigated the outcome and donor-site morbidity of the free radial forearm flap and the free medial sural artery perforator flap for head and neck reconstruction.
Methods: Between July of 2004 and May of 2008, 47 patients (45 men and two women) underwent head and neck reconstruction, with a free radial forearm flap used in 29 cases and a free medial sural artery perforator flap used in 18 cases. Patient age ranged from 30 to 70 years (mean, 50.5 years).
Results: The success rate of free radial forearm and free medial sural artery perforator flaps was 100.0 percent. There was no significant difference in flap harvest time (57.5 minutes versus 60 minutes), hospital stay (24.5 days versus 19.7 days), or overall recipient-site complication rate (20.7 percent versus 11.1 percent). The free medial sural artery perforator flap group had a better subjective functional and cosmetic outcome in the donor site than the free radial forearm flap group (two-sided Fisher's exact test, p = 0.0002).
Conclusions: The medial sural artery perforator flap is a good alternative for head and neck reconstruction of small defects. The medial sural artery perforator flap is advantageous with regard to less donor-site morbidity compared with the free radial forearm flap. The unfamiliarity of the pedicle anatomy of the medial sural artery perforator flap must be weighed against an easily harvested radial forearm flap.