{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:27:54Z","timestamp":1785767274452,"version":"3.56.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>Chronic osteomyelitis is very difficult to treat, numerous reconstructive strategies have been described for repairing soft tissue defect combined with chronic osteomyelitis in the foot and ankle. The free chimeric medial sural artery perforator (cMSAP) flap has been recommended for reconstructing the complicated wounds. We conducted a retrospective study on 16 patients who accepted cMSAP flap to reconstruct the soft tissue defect in the setting of chronic osteomyelitis in foot and ankle from January 2021 to December 2023. The effect of surgery and the functional evaluation of the limb were assessed. Results displayed that no chronic osteomyelitis was recurrent, no cases needed bulky flap defatting and the functions of the lower extremity were all improved at the last follow-up. The free cMSAP flap is a good alternative for reconstructing complex soft tissue defects with deep dead space in the setting of chronic osteomyelitis in the foot and ankle.<\/jats:p>","DOI":"10.3389\/fcimb.2025.1689817","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T06:28:17Z","timestamp":1763965697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Free cMSAP flap for the treatment of chronic osteomyelitis with complex soft tissue defects in foot and ankle"],"prefix":"10.3389","volume":"15","author":[{"given":"Shu","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zili","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runxin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e82\u2013e88","DOI":"10.1055\/s-0043-1770956","article-title":"Reconstruction of upper and lower limb defects with medial sural artery perforator flaps: is aesthetics worth the effort? A retrospective analysis","author":"Alharbi","year":"2023","journal-title":"Surg. J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1002\/ohn.348","article-title":"Medial sural artery perforator flap: A middle ground between anterolateral thigh and radial forearm flaps","volume":"169","author":"Arman Danielian","year":"2023","journal-title":"Otolaryngology: Head Neck Surgery."},{"key":"B3","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/S0894-1130(12)80292-4","article-title":"Testing sensibility, including touch-pressure, two-point discrimination, point localization, and vibration","volume":"6","author":"Bell-Krotoski","year":"1993","journal-title":"J. Handb. Ther."},{"key":"B4","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3389\/fcimb.2024.1508424","article-title":"Impact of VSD therapy on surgical outcomes, inflammatory markers, and functional rehabilitation in patients with secondary bone infection following tibial fracture surgery","author":"Chang","year":"2025","journal-title":"Front. Cell. Infection Microbiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"102070","DOI":"10.1016\/j.hansur.2024.102070","article-title":"Free medial sural artery perforator flap for soft tissue defects in the hand: a cadaver study","volume":"44","author":"Coulet","year":"2025","journal-title":"Handb. Surg. Rehabilitation."},{"key":"B6","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/SAP.0000000000001488","article-title":"A comparative clinical study of flap thickness","volume":"81","author":"Doan","year":"2018","journal-title":"Ann. Plast. Surgery."},{"key":"B7","doi-asserted-by":"publisher","first-page":"259\u201364","DOI":"10.1002\/micr.22074","article-title":"Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children","volume":"33","author":"El-Gammal","year":"2013","journal-title":"Microsurgery."},{"key":"B8","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/SAP.0b013e31818b4cc4","article-title":"An introduction to the chimeric deep inferior epigastric artery perforator (DIEAP)-rectus abdominis muscle flap","volume":"61","author":"Hallock","year":"2008","journal-title":"Ann. Plast. Surgery."},{"key":"B9","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/01.prs.0000293859.60618.79","article-title":"The combined parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap","volume":"121","author":"Hallock","year":"2008","journal-title":"Plast. Reconstructive Surgery."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e6853","DOI":"10.1097\/GOX.0000000000006853","article-title":"An intraoperative study of flap thickness between medial sural artery, anterolateral thigh, and radial forearm flaps","volume":"13","author":"Haq","year":"2025","journal-title":"Plast. Reconstructive Surgery-Global Open"},{"key":"B11","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/PRS.0000000000003460","article-title":"The efficacy of perforator flaps in the treatment of chronic osteomyelitis","volume":"140","author":"Hong","year":"2017","journal-title":"Plast. Reconstructive Surgery."},{"key":"B12","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/S0094-1298(03)00046-4","article-title":"Chimeric flap in clinical use","volume":"30","author":"Huang","year":"2003","journal-title":"Clinics Plast. Surgery."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1097\/PRS.0b013e3181b457cf","article-title":"Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions","volume":"124","author":"Kao","year":"2009","journal-title":"Plast. Reconstructive Surgery."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1097\/PRS.0b013e3181b457cf","article-title":"Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions","volume":"124","author":"Kao","year":"2009","journal-title":"Plast. Reconstructive Surgery."},{"key":"B15","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.anplas.2011.01.004","article-title":"Baropodometric analysis of the functional donor-site morbidity after gastrocnemius or soleus muscle-flap procedure","volume":"56","author":"Lasserre","year":"2011","journal-title":"Ann. Chir Plast. Esthet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/S0140-6736(04)16727-5","article-title":"Osteomyelitis","volume":"364","author":"Lew","year":"2004","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"249\u2013257","DOI":"10.1016\/j.cps.2021.01.003","article-title":"The medial sural artery perforator flap in lower extremity reconstruction","volume":"48","author":"Lin","year":"2021","journal-title":"Clinics Plast. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"100252","DOI":"10.1016\/j.jham.2025.100252","article-title":"Review and algorithmic management of the anatomical variations of the medial sural artery perforator flap","volume":"17","author":"Lin","year":"2025","journal-title":"J. Handb. Microsurgery."},{"key":"B19","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1177\/1534734620956782","article-title":"Distally based peroneal artery perforator-plus fasciocutaneous flap to reconstruct soft tissue defect combined with chronic osteomyelitis in the lateral malleolus","volume":"21","author":"Luo","year":"2020","journal-title":"Int. J. Lower Extremity Wounds."},{"key":"B20","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.bjps.2017.03.004","article-title":"Restoration of basic hand function following devastating hand injuries using a microsurgically fabricated chimeric iliac osteocutaneous flap","volume":"70","author":"Pan","year":"2017","journal-title":"J. Plastic Reconstructive Aesthetic Surgery."},{"key":"B21","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.bjps.2008.07.018","article-title":"Treatment of chronic osteomyelitis using the medial sural perforator flap","volume":"63","author":"Park","year":"2010","journal-title":"J. Plast. Reconstructive Aesthetic Surg. Jpras."},{"key":"B22","doi-asserted-by":"publisher","first-page":"612\u20139","DOI":"10.1186\/s13018-023-03852-z","article-title":"Individualized design of thoracodorsal artery perforator chimeric flap for customized reconstruction of complex three-dimensional defects in the extremities","volume":"18","author":"Qing","year":"2023","journal-title":"J. Orthopaedic Surg. Res."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.bjps.2018.05.029","article-title":"Use of dual-skin paddle anterolateral thigh perforator flaps in the reconstruction of complex defect of the foot and ankle","volume":"71","author":"Qing","year":"2018","journal-title":"J. Plastic Reconstructive Aesthetic Surgery."},{"key":"B24","doi-asserted-by":"publisher","first-page":"98\u201310","DOI":"10.1097\/00003086-197310000-00015","article-title":"The treatment of chronic osteomyelitis by saucerization and immediate skin grafting","author":"Shannon","year":"1973","journal-title":"Clin. Orthopaedics Related Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2679","DOI":"10.1111\/iwj.14142","article-title":"The free chimeric medial sural artery perforator flap for individualised and three-dimensional reconstruction of complex soft-tissue defects in extremities","volume":"20","author":"Sui","year":"2023","journal-title":"Int. Wound J."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22127","article-title":"Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children","volume":"33","author":"Tang","year":"2013","journal-title":"Microsurgery."},{"key":"B27","doi-asserted-by":"publisher","first-page":"593","DOI":"10.7507\/1002-1892.202312079","article-title":"Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps","volume":"38","author":"Tao","year":"2024","journal-title":"Chin. J. Reparative Reconstructive Surgery."},{"key":"B28","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/01.sap.0000116242.26334.b5","article-title":"The medial sural artery perforators","volume":"53","author":"Thione","year":"2004","journal-title":"Ann. Plast. Surgery."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1097\/01.prs.0000200615.77678.f1","article-title":"Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing","volume":"117","author":"Yang","year":"2006","journal-title":"Plast. Reconstructive Surgery."},{"key":"B30","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s40902-024-00455-4","article-title":"Medial sural artery perforator free flap for small- to medium-sized defects in head and neck reconstruction: a suitable replacement for radial forearm free flap","volume":"47","author":"Zhang","year":"2025","journal-title":"Maxillofac. Plast. Reconstructive Surgery."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1689817\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T06:28:19Z","timestamp":1763965699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1689817\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":30,"alternative-id":["10.3389\/fcimb.2025.1689817"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1689817","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]},"article-number":"1689817"}}