The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction

Clin Plast Surg. 2021 Apr;48(2):249-257. doi: 10.1016/j.cps.2021.01.003. Epub 2021 Feb 5.


Medial sural artery perforator (MSAP) flap is a thin, pliable, and versatile flap. It is a fasciocutaneous flap with chimeric design capacity. The donor site permits the synchronous harvesting of nonvascularized tendons and nerves. Free MSAP flap is suitable for foot, ankle, and distal one-third of the leg reconstructions. Pedicled MSAP flap is an alternative flap for knee and proximal two-thirds of leg defects, covering classical lower limb reconstruction territories of soleus, medial, and lateral gastrocnemius muscle flap. Computed tomography angiography, indocyanine green, and endoscopic-assist dissection enhances MSAP flap surgical planning and reduces its technical adversities and complications.

Keywords: Free tissue transfer; Lower extremity reconstruction; Medial sural artery perforator flap; Microsurgery; Pedicled perforator flap; Soft tissue reconstruction.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Arteries / surgery
  • Endoscopy
  • Female
  • Humans
  • Lower Extremity / diagnostic imaging
  • Lower Extremity / surgery*
  • Male
  • Middle Aged
  • Perforator Flap / blood supply*
  • Plastic Surgery Procedures / methods*
  • Soft Tissue Injuries / surgery