Pedicled double-paddle conjoined medial sural artery perforator flap for popliteal defect coverage after skin tumor excision: A case report

Defect coverage in the popliteal region represents a challenging task because of its peculiar features. The tissue here has to be thin and pliable, to enable proper function, but also resistant to the high stress forces typical of this region. In addition, the adjacent skin is limited in availability and mobility. Therefore, complex reconstruction procedures are usually required to cover defects in the popliteal region. The medial sural artery perforator (MSAP) flap is a thin and pliable flap, with a long arc of rotation provided by its pedicle length, which makes it a suitable procedure for local and regional defects reconstruction. In the present work, we report the use of a pedicled double-paddle conjoined MSAP flap to reconstruct a 7 cm x 7 cm soft tissue defect after resection of a basal cell carcinoma in the popliteal fossa. The MSAP flap was based on two perforators of the medial sural artery. Therefore, the cutaneous island could be split into two islands, which were rearranged to cover the defect side by side in a so-called "kissing flap" technique. The further postoperative course was uneventful. Despite the complex perforator dissection, which can be challenging because of its intramuscular dissection, we believe that the MSAP flap represents a valid solution for local defect coverage in the popliteal region, providing a sufficient amount of tissue and meeting the "like-with-like" criteria.