# Medial Sural Artery Perforator Flap for Tongue and Oral Cavity Reconstruction With Native Tongue Tip Preservation: Report of Three Cases

## TL;DR

This paper presents three cases where a specific flap was used to reconstruct tongue and oral cavity defects, preserving tongue tip mobility and achieving good functional outcomes.

## Contribution

The novel use of the medial sural artery perforator flap for tongue reconstruction with native tongue tip preservation is highlighted.

## Key findings

- MSAP flaps provided favorable pliability and volume for tongue reconstruction.
- Preserving the unattached tongue tip enhanced mobility and functional recovery.
- All patients resumed oral feeding and had inconspicuous donor site scars.

## Abstract

Compartmental hemiglossectomy for oral cavity squamous cell carcinoma creates composite tongue/floor defects in which balancing mobility, bulk, and a supple lining is challenging. We report three consecutive reconstructions using a medial sural artery perforator (MSAP) flap, emphasizing preservation of the uninvolved tongue tip left intentionally unattached to maximize residual mobility. A 28‐year‐old woman, a 50‐year‐old man, and a 36‐year‐old woman with lateral tongue SCC underwent compartmental resection with selective neck dissection; defects measured ~4 × 3, 5 × 4, and 6 × 5 cm. Thin fasciocutaneous MSAP flaps (5 × 4, 6 × 5, and 7 × 6 cm) were harvested from the medial calf and inset intraorally after tumor ablation, with end‐to‐end microvascular anastomoses to cervical recipient vessels (typically the lingual or superior thyroid artery and the external or internal jugular vein). All flaps survived without surgical complications; donor sites were closed primarily. Oral feeding resumed on postoperative day 13, 18, and 12, respectively; speech was comprehensible in all cases after standard rehabilitation. Follow‐up occurred 6 months after completion of adjuvant radiotherapy (case 1), during adjuvant radiotherapy (case 2), and 3 months after completion (case 3) with all patients tolerating a full oral diet of any consistency and calf scars were linear and inconspicuous with no lower‐limb deficits. These findings suggest that, for medium‐sized lateral tongue/floor defects, the MSAP provides a favorable balance of pliability and volume with low donor‐site morbidity; when oncologically feasible, preserving and not suturing the native tongue tip may further enhance mobility and functional recovery.