The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small‐to‐moderate size defects of the foot and ankle

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. Conclusion 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.