Purpose:
Medial sural artery perforator (MSAP) flap is a thin, pliable, versatile flap for knee, lower leg, ankle and foot reconstructions. With appropriate measures, it is possible to utilize an ipsilateral pedicled MSAP flap to cover the defect from the knee to the lower-third of leg. We report our experience and provide a step by step approach to achieve the reconstruction goal.

Materials and Methods:
We conducted a retrospective review of lower leg reconstruction using the ipsilateral MSAP flap in a 7 year period. Patient demographics, defect etiology and characteristics, type of MSAP flap reconstruction, donor site management, complications, and outcome were documented. We propose a treatment algorithm, mainly based on the defect location and perforator availability. Defect location is classified into upper, middle, lower-third of the leg. Pre-operative verification of the perforator is done with a handheld Doppler probe.

Results:
A total of 30 cases were collected and analyzed. The etiologies of defects included trauma, diabetic ulcers, chronic ulceration, cancer, post debridement. Four different types of techniques were identified: pedicled, pedicled propeller, reverse-flow propeller and free-stylepropeller. The size of flaps were ranging from 20-60 cm2. All flaps survived, and all patients returned to work. All donor sites were closed primarily.

Conclusions:
The ipsilateral pedicled MSAP flap is a versatile reconstruction option and can provide favorable results, all together with minimal donor site morbidity. We believe our step by step approach can facilitate the decision-making process of the ipsilateral MSAP flap and provide reliable lower extremity reconstruction.

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