https://www.selleckchem.com/products/pf-06882961.html 109 free flaps were analyzed. 7 patients were excluded. The majority of patients were male (75.9%) and required reconstruction due to acute trauma (68.1% vs 31.9% for chronic wounds). There was no statistically significant association found between age, BMI, or timing of trauma with venous congestion, flap failure, or other flap related covariates. In patients with significantly elevated C-RAM scores, there was no significant association between VTE risk and flap failure following free tissue reconstruction of lower extremities. In patients with significantly elevated C-RAM scores, there was no significant association between VTE risk and flap failure following free tissue reconstruction of lower extremities. The medial sural artery perforator flap is a versatile option in reconstructive microsurgery. However, most reports of this flap have been limited by sample size. This study reviews the experience of a single large-volume center using the medial sural artery perforator flap and its variants for a variety of reconstructive purposes. A retrospective review of all patients who received the medial sural artery perforator flap reconstruction between March of 2006 and July of 2014 was performed. Two-hundred medial sural artery perforator flaps were used at three anatomical regions head and neck (n = 129), upper extremity (n = 47), and lower extremity (n = 24). Flaps were transferred as free (n = 189) and pedicled (n = 11). Overall flap survival was 96 percent. Flap variants used included chimeric flap (n = 11) and dual skin paddle (n = 2). Plantaris tendon and saphenous/sural nerve graft were harvested in conjunction in 20 and seven patients, respectively. In 5 percent of the cases harvested in the conventional manner, a reliable perforator could not be found. The medial sural artery perforator flap is a reliable, alternative workhorse flap for nearly any small- to medium-size defect. It can be harvested as free o