The need for thin flap coverage has increased, especially for contouring or covering shallow defect of distal limb. The author present his experience with the free medial sural artery perforator flap for this purpose. The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The main advantage of the medial sural artery perforator flap is that it requires only cutaneous tissue to achieve better accuracy in reconstruction and preserves the medial gastrocnemius muscle and its motor nerve to minimize donor-site morbidity. We used this flap in 11 clinical cases for distal limb reconstruction. Skin defects among all patients were caused by scar contracture release, trauma, and chronic ulcer. The flap is supplied by the proximal perforator, which can be identified along the axis of the medial sural artery and usually emerges in an area between 6 and 10 cm from the popliteal crease and 5 cm from the posterior midline of the leg. However, the tedious intramuscular retrograde dissection of the perforator, up to the medial sural artery, is required to obtain suitable length and vessel diameter. The author concludes that the free medial sural artery perforator flap has greater potential for resurfacing moderate defects of distal limb, because of its reliability, thinnesss, and easy elevation.
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