The Medial Sural Artery Perforator Flap: Lessons Learned from 200 Consecutive Cases.

BACKGROUND The medial sural artery perforator flap is a versatile option in reconstructive microsurgery. However, most reports of this flap have been limited by sample size. This study reviews the experience of a single large-volume center using the medial sural artery perforator flap and its variants for a variety of reconstructive purposes. METHODS A retrospective review of all patients who received the medial sural artery perforator flap reconstruction between March 2006 and July 2014 was performed. RESULTS Two-hundred medial sural artery perforator flaps were used at 3 anatomic regions: head and neck (n=129), upper extremity (n=47), and lower extremity (n=24). Flaps were transferred as free (n=189) and pedicled (n=11). Overall flap survival was 96%. Flap variants used included chimeric flap (n=11) and dual skin paddle (n=2). Plantaris tendon and saphenous/sural nerve graft were harvested in conjunction in 20 and 7 patients, respectively. In 5% of the cases harvested in the conventional manner, a reliable perforator could not be found. CONCLUSION The medial sural artery perforator flap is a reliable, alternative workhorse flap for nearly any small to medium-sized defect. It can be harvested as free or pedicled and the option to include multiple tissue components further expands its versatility.