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Background <p>Reconstructing complex soft-tissue defects of the hand remains a surgical challenge, as standard workhorse flaps often result in donor morbidity or excessive bulk. This study prospectively evaluated the medial sural artery perforator (MSAP) flap as an alternative, focusing on clinical reliability, validated functional outcomes, and objective structural analysis.</p> Methods <p>A prospective case series was conducted between July 2022 and June 2024, enrolling 20 consecutive patients with complex hand or distal forearm defects. The primary outcome was flap survival. Secondary outcomes assessed at a minimum of 12 months included complications, functional status using the Disabilities of the Arm, Shoulder and Hand (DASH) and Michigan Hand Questionnaire (MHQ), patient satisfaction, and objective flap thickness measured by high-frequency ultrasound using a validated gel stand-off technique to eliminate compression artefact.</p> Results <p>The cohort (mean age 34.8 years; 80% post-traumatic) achieved a 100% flap survival rate. Minor complications occurred in 25% of patients and were managed conservatively. At the 12-month follow-up, functional outcomes were excellent, with a mean DASH score of 3.0 ± 1.4 indicating minimal disability, and a mean MHQ score of 71.4 ± 8.2. All patients rated their outcome as ‘good’ or ‘very good’. Ultrasound analysis revealed a mean flap thickness of 4.7 ± 0.7&#xa0;mm, significantly thicker than native skin (3.0 ± 0.8&#xa0;mm; <i>p</i> &lt; 0.001) yet sufficiently thin to avoid bulkiness.</p> Conclusions <p>The MSAP flap proves to be a reliable option for hand reconstruction, demonstrating excellent survival and favourable postoperative functional status. Objective ultrasound measurement confirms that this flap provides effective, durable coverage without the excessive bulk associated with other options, potentially minimising the need for secondary debulking. Flap thickness is importantly influenced by patient BMI and ethnic habitus, and these variables should be incorporated in future comparative studies.</p> <p>Level of Evidence: Level IV, therapeutic study.</p>

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Functional outcomes and objective thickness of the Medial Sural Artery Perforator (MSAP) flap for hand resurfacing: a prospective case series with ultrasound analysis

  • 期刊论文

  • 发表日期：

    2026年4月15日

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  • Mohamed Ali Almarakby,
  • Mohamed Fatahalla Al ghandour,
  • Ahmed Mohamed Bahaa El-Din,
  • Mohammed Hassan El Fahar

摘要

Background

Reconstructing complex soft-tissue defects of the hand remains a surgical challenge, as standard workhorse flaps often result in donor morbidity or excessive bulk. This study prospectively evaluated the medial sural artery perforator (MSAP) flap as an alternative, focusing on clinical reliability, validated functional outcomes, and objective structural analysis.

Methods

A prospective case series was conducted between July 2022 and June 2024, enrolling 20 consecutive patients with complex hand or distal forearm defects. The primary outcome was flap survival. Secondary outcomes assessed at a minimum of 12 months included complications, functional status using the Disabilities of the Arm, Shoulder and Hand (DASH) and Michigan Hand Questionnaire (MHQ), patient satisfaction, and objective flap thickness measured by high-frequency ultrasound using a validated gel stand-off technique to eliminate compression artefact.

Results

The cohort (mean age 34.8 years; 80% post-traumatic) achieved a 100% flap survival rate. Minor complications occurred in 25% of patients and were managed conservatively. At the 12-month follow-up, functional outcomes were excellent, with a mean DASH score of 3.0 ± 1.4 indicating minimal disability, and a mean MHQ score of 71.4 ± 8.2. All patients rated their outcome as ‘good’ or ‘very good’. Ultrasound analysis revealed a mean flap thickness of 4.7 ± 0.7 mm, significantly thicker than native skin (3.0 ± 0.8 mm; p < 0.001) yet sufficiently thin to avoid bulkiness.

Conclusions

The MSAP flap proves to be a reliable option for hand reconstruction, demonstrating excellent survival and favourable postoperative functional status. Objective ultrasound measurement confirms that this flap provides effective, durable coverage without the excessive bulk associated with other options, potentially minimising the need for secondary debulking. Flap thickness is importantly influenced by patient BMI and ethnic habitus, and these variables should be incorporated in future comparative studies.

Level of Evidence: Level IV, therapeutic study.