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Case report
Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction
  1. Natalia Mazur1,2,
  2. Rik Osinga2,3 and
  3. Steven Lo2,4
  1. 1Medical School, Medical University of Gdansk, Gdansk, Poland
  2. 2Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
  3. 3Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
  4. 4Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  1. Correspondence to Dr Rik Osinga; rik.osinga{at}


Reconstruction of composite defects of the posterior thigh and knee is challenging. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. More recently, the medial sural artery perforator (MSAP) flap has been described for such defects, although may necessitate skin grafting of the donor site. To minimise the drawbacks with these options, we describe a combination of a median superficial sural artery perforator (MSSAP) flap and MSAP flap. This allows both tension free closure of the donor site without skin grafting, and facilitates coverage of a round defect by splitting the flap into two adjacent triangular flaps. This is the first report of posterior thigh defect reconstruction with a combination of MSSAP and MSAP flaps.

  • plastic and reconstructive surgery
  • surgical oncology
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  • Contributors NM and RO are shared first authors as they have contributed equally to this manuscript. They both have contributed significantly and drafted/revised the work together. SL is last author as he was responsible for the conception and design of the work and operated the patient together with RO. He finalised the latest version of the manuscript. All authors agree to be accountable for all aspects of the work presented.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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