Free Medial Sural Artery Perforator Flap for Ankle and Foot Reconstruction

Abstract

Resurfacing shallow defects over the ankle and foot with an appropriately thin flap is a common but difficult task. This can be accomplished by harvesting the medial sural artery perforator flap from the medial aspect of the upper calf. Based on the musculocutaneous perforator of the medial sural artery, this flap preserves the medial gastrocnemius muscle and avoids unnecessary flap bulkiness. Between January 2002 and February 2004, we used 2 variants of the free medial sural artery perforator flap for ankle and foot reconstruction in 13 patients (10 fasciocutaneous flaps and 3 adipofascial flaps). In these patients, skin defects were combined with bone, joint, or tendon exposure. The main advantage of this flap is that it provides a thin and pliable coverage to achieve better accuracy in the reconstructive site. Other advantages include maintaining the function of the medial gastrocnemius muscle, providing a long vascular pedicle, and avoiding the need to sacrifice major arteries of the leg. The main disadvantages are the tedious process of intramuscular retrograde dissection of the perforator and the unsightly skin graft over the medial calf.

Plantar Reconstruction Using the Medial Sural Artery Perforator Free Flap

“…20,21 Nevertheless, to the best of the authors' knowledge, no report has been issued on the use of medial sural artery perforator flaps for the reconstruction of plantar defects. 22,23 Although the gastrocnemius muscle and musculocutaneous flaps have been widely used to cover defects over the knee and the proximal third of the tibia for a long time, 24 the accurate distribu- tions of the cutaneous vascular branches of the calf region were only investigated recently. Taylor and Daniel, 25 in a cadaveric study, described the possibility of using the medial calf region as a potential free flap donor site in 1975, but this suggestion was not explored clinically until Montegut and Allen 26 presented the first clinical case involving the sural artery perforator pedicled flap in 1996.…”

Medial sural artery perforator free flap for the reconstruction of leg, foot and ankle defect: an excellent option

“…Chen et al . in 2005 have used MSAP free flap for the reconstruction of defects around the foot and ankle region. The use of MSAP flap for the reconstruction of the plantar defects were done by Kim et al .…”

Medial Sural Artery Perforator Flap for Repair of the Hand

“…It has been used little to repair defects of the hand, although Chen et al (2005a) included four patients with soft tissue defects of the hand in their report of 11 clinical cases.…”