Early experience with the medial sural artery perforator flap as an alternative to the radial forearm flap for reconstruction in the head and neck

Abstract The medial sural artery perforator (MSAP) flap has been well-described but has yet to find popularity in the United Kingdom. We describe our early experience of its use in 6 patients and our simplified method of marking up. Flaps ranged in size from 7 × 4 cm to 12 × 5.5 cm, and were thin (between 4 and 10 mm). Pedicles were between 11 and 14 cm long, arterial diameters were 1–2 mm, and venous calibres were 2–6 mm. We raised 4 flaps without the use of a tourniquet and found it helpful. Straightening the leg as the popliteal fossa was approached also eased dissection. There can be 2 separate pedicles. The donor site was closed primarily in 5 cases and all flaps survived. The MSAP is easier to do than the radial artery forearm free flap (RAFFF) and is a reliable alternative with low morbidity.