{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:27:53Z","timestamp":1785767273270,"version":"3.56.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,10,5]],"date-time":"2016-10-05T00:00:00Z","timestamp":1475625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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\u2010to\u2010moderate size defects by comparing the outcome depending on the region of reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010two patients with variable defects of 4 \u00d7 4 to 18 \u00d7 7 cm underwent MSAP flap reconstruction. Final outcomes of all patients were evaluated 12\u2010months postoperatively using the AOFAS ankle\u2010hindfoot, midfoot and hallux scale for clinical\u2010functional evaluation, and the SF\u201036 health survey for quality\u2010of\u2010life measurement. The scores were compared in three groups according to the anatomic region of MSAP flap reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The flap size ranged between 6 \u00d7 4 and 21 \u00d7 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\u2010hindfoot or hallux showed significantly lower AOFAS ankle\u2010hindfoot (<jats:italic>P<\/jats:italic>\u2009=\u20090.021) or hallux scores (<jats:italic>P<\/jats:italic>\u2009=\u20090.034), whereas reconstruction of the midfoot led to equal AOFAS midfoot scores (<jats:italic>P<\/jats:italic>\u2009=\u20090.265) as compared with patients without reconstruction in the respective region. Comparison of SF\u201036 physical (<jats:italic>P<\/jats:italic>\u2009=\u20090.936) and mental (<jats:italic>P<\/jats:italic>\u2009=\u20090.855) scores of all three regions remained insignificant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010hindfoot or hallux region depend on the preexistent functional impairment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30100","type":"journal-article","created":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T17:50:06Z","timestamp":1476294606000},"page":"34-45","source":"Crossref","is-referenced-by-count":32,"title":["The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small\u2010to\u2010moderate size defects of the foot and ankle"],"prefix":"10.1002","volume":"38","author":[{"given":"Zaher","family":"Jandali","sequence":"first","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin C.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiomars","family":"Aganloo","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Merwart","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jouke","family":"Buissink","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Surgery Asklepios Klinik Barmbek, Asklepios Medical School Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian P.","family":"Jiga","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic, Reconstructive and Hand Surgery Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-1226(03)00125-5"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200111000-00027"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2013.09.005"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200502000-00016"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000141376.15470.9b"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20712"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e318157a1a0"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1343959"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200203000-00032"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00103-004-0933-1"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000116338.59679.12"},{"key":"e_1_2_7_13_1","first-page":"187","article-title":"Medial sural artery perforator free flap: Legitimate use as a solution for the ipsilateral distal lower extremity defect","volume":"30","author":"Hallock G. 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