Background and objective.

The medial sural artery perforator (MSAP) flap was first described as a refinement of the medial gastrocnemius flap. Despite its recent history, it has already proven to have several advantages and indications, namely in lower extremity reconstruction.

The authors present a retrospective case series with lower limb soft-tissue defects which were reconstructed with the MSAP flap.

Methods.

Between 2013 and 2018, 10 patients were operated on: 6 men and 4 women, ranging in age from 27 to 86 years.

The main etiology of the defects was traumatic injury. The defects located between the distal third of the thigh and the proximal third of the leg were covered with pediculated flaps while the distal defects were covered with free flaps.

Results.

The mean flap dimensions were 6.35 cm width, 10.9 cm length, and 9.9 cm pedicle length. All flaps except 1 were raised with a single perforator.

Apart from 1 case of partial free-flap loss, there were no short-term complications. Two patients required skin grafting of the donor site while the remaining were closed directly.

The mean follow-up time was 22.8 months and there were no donor site complaints. A stable and aesthetically satisfactory coverage was obtained in all cases.

Conclusions.

The MSAP flap is a thin and pliable fasciocutaneous flap that can provide “like-with-like” tissue with minor donor site morbidity in lower limb reconstruction. Less positive characteristics include a potential laborious intramuscular dissection and occasional venous congestion. Still, the good results and satisfaction of the patients make this a wise choice in selected cases.

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