title: The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small-to-moderate size defects of the foot and ankle.
abstract: BACKGROUND
  The medial sural artery perforator (MSAP) flap shows advantages for reconstruction in the foot and ankle, where bulk is a liability. We evaluated the versatility of this flap and provide further evidence on its use for covering small-to-moderate size defects by comparing the outcome depending on the region of reconstruction.
  
  
  METHODS
  Twenty-two patients with variable defects of 4 × 4 to 18 × 7 cm underwent MSAP flap reconstruction. Final outcomes of all patients were evaluated 12-months postoperatively using the AOFAS ankle-hindfoot, midfoot and hallux scale for clinical-functional evaluation, and the SF-36 health survey for quality-of-life measurement. The scores were compared in three groups according to the anatomic region of MSAP flap reconstruction.
  
  
  RESULTS
  The flap size ranged between 6 × 4 and 21 × 9 cm. One venous congestion was salvaged by venous thrombectomy and reanastomosis, and one marginal flap necrosis healed by secondary intention. All flaps survived, and all patients returned to ambulation. Patients with reconstruction of the ankle-hindfoot or hallux showed significantly lower AOFAS ankle-hindfoot (P = 0.021) or hallux scores (P = 0.034), whereas reconstruction of the midfoot led to equal AOFAS midfoot scores (P = 0.265) as compared with patients without reconstruction in the respective region. Comparison of SF-36 physical (P = 0.936) and mental (P = 0.855) scores of all three regions remained insignificant.
  
  
  CONCLUSIONS
  The MSAP flap provides thin soft tissue coverage, enabling good functional recovery after defect reconstruction all around the foot and ankle, with evident advantages in the midfoot. However, the functional outcomes after reconstruction of the ankle-hindfoot or hallux region depend on the preexistent functional impairment.
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Jandali
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Lam
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Kiomars
authors.initials: K
authors.lastname: Aganloo
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Merwart
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Jouke
authors.initials: J
authors.lastname: Buissink
authors.affiliation: Department of Plastic, Aesthetic and Reconstructive Surgery, Asklepios Klinik Barmbek, Asklepios Medical School, Hamburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Müller
authors.affiliation: Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
authors.forename: Lucian P
authors.initials: LP
authors.lastname: Jiga
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D001158:Arteries / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: distal lower extremity; foot and ankle; free tissue transfer; medial sural artery perforator flap; soft tissue reconstruction