Figure 3: Illustration of a case of medial sural artery perforator flap. (a) The defect. (b) Flap design. (c) Flap elevation. (d) Flap inset. (e) Flap postoperatively. (a) The defect is chronic ulcer over tibia of the right leg. (b) Flap design with marking perforators (c) flap is elevated with fascia sutured to it, preventing shearing movement. (d) Flap inset (e) postoperative view showing satisfactory flap coverage of ulcer defect.