Michael Nugent

Early experience with the medial sural artery perforator flap as an alternative to the radial forearm flap for reconstruction in the head and neck

The medial sural artery perforator (MSAP) flap has been well-described but has yet to find popularity in the United Kingdom. We describe our early experience of its use in 6 patients and our simplified method of marking up. Flaps ranged in size from 7×4cm to 12×5.5cm, and were thin (between 4 and 10mm). Pedicles were between 11 and 14cm long, arterial diameters were 1-2mm, and venous calibres were 2-6mm. We raised 4 flaps without the use of a tourniquet and found it helpful. Straightening the leg as the popliteal fossa was approached also eased dissection. There can be 2 separate pedicles. The donor site was closed primarily in 5 cases and all flaps survived. The MSAP is easier to do than the radial artery forearm free flap (RAFFF) and is a reliable alternative with low morbidity.

Third molar consent forms: how comprehensive should they be?

To establish a gold standard for the information given to patients about the risks associated with third molar extractions, we surveyed 79 oral and maxillofacial surgeons (OMFS) to find out what information they gave to patients during the consent process. We also surveyed 62 medicolegal solicitors to find out what information they thought patients should be given before the procedure, and in what form. A total of 20/76 OMFS (26%) used a two-stage process to obtain consent; 13 (17%) included paraesthesia on the consent form and also gave out an information leaflet. All the lawyers agreed that patients should give their consent in writing and thought that the risk of paraesthesia should be included on the form. Three-quarters thought that they should also be given an information leaflet that includes paraesthesia. We encourage surgeons to do this as part of the two-stage consent process.

Split table improves access for harvest of medial sural artery perforator flap.

We have recently described our early experience with he medial sural artery perforator flap for reconstruction in he head and neck,1 and it has become the workhorse flap or smaller defects in our practice. Whilst it reduces moridity for the patient, there is a paradoxical impact for the urgeon.2 Access to the posteromedial calf can be awkward hen the patient is supine. Authors have previously described he hip being abducted, the knee bent, and the leg rotated xternally.1,2 Others describe use of the prone operating posiion to raise the flap,3 but it prevents two-team operating n head and neck work, and prolongs the operating time. ecently, we have used a split operating table. This allows he surgeon to sit between the patient’s legs and makes the perating position during harvest of the flap more comfortble (Fig. 1). We have not found previous mention of this imple strategy to improve access.