Abstract
The medial sural artery perforator (MSAP) flap captures the cutaneous territory of
the medial calf, and can potentially be advantageous as a thin free flap, even in
the most obese individual, for coverage of most foot and/or ankle defects where bulk
is a liability. The anatomy is fairly constant, as usually at least one reasonably
large perforator can always be found emanating from the medial head of the gastrocnemius
muscle. As a microsurgical tissue transfer, a long vascular pedicle of large caliber
is routinely possible which facilitates any requisite microanastomoses.
Over the past decade from our free flap registry, 14 patients with distal lower extremity
wounds were covered specifically with a perforator flap based on the ipsilateral medial
sural artery; out of which only 2 (14%) were females.
In this series using a MSAP free flap, there was only one failure requiring salvage
by a different free flap. All but one case was a sequel of trauma, and these involved
all zones of the foot and ankle. A skin graft of the donor site was necessary in 5/14
(36%) patients. In no cases did the flap subsequently impede the use of shoes nor
hinder ambulation.
The study concluded the major disadvantage of the MSAP flap is the nonaesthetic scar
left at the donor site which can be quite conspicuous, especially if a skin graft
had to be used. Yet even this detriment can be acceptable for ipsilateral distal lower
extremity defects where reconstruction of the defect itself may be cosmetically unappealing.
This may be the best indication for the MSAP flap to be considered first as the free
flap of choice.
Keywords
medial sural artery perforator free flap - microvascular surgery - lower extremity
- foot and ankle
