Clinical Experience with the Medial Sural Artery Perforator Free Flap

The medial sural artery perforator free flap (M-SAP) is a genuine perforator flap, recently described. It is a reliable and safe flap, although it has not gained wide acceptance.

A series of 22 free M-SAP flaps was reported. There were 21 males and 1 female patient, aged 17–54 years. Defects included traumatic foot defects in 21 cases, and one intraoral oncological defect. Twenty-one flaps were successful, with one failure after revision (the intraoral case). The donor area was directly closed in every case.

The M-SAP flap, as a free regional flap, is a valuable reconstructive tool for foot wounds. Flap elevation is rapid, although pedicle dissection may be tedious. The anatomy is relatively constant, the pedicle length can be significant, and donor morbidity is acceptable, providing that direct closure is possible. For small-to-moderate-sized defects of the foot, especially when a long, middle-sized pedicle is needed, the M-SAP free flap may be a good choice.