The study aims to discrible the application of medial sural artery perforator flap (MSAP) in reconstruction of defects in the head and neck and the extremities. Results show that all the flaps survived, except for one. Flap dimensions ranged from 4x8 cm to 9x20 cm. Flap was composed of: skin and fascia, 6 cases: skin and muscle, 19 cases. There were 9 pedicled flaps and 16 free flaps In conclusion, this study showed that MSAP flap is a reliable and new useful tool for soft-tissue defect reconstruction. This technique improved the appearance of the recipient site, minimized donor-site morbidity, and enhanced the function and refinement of the flap.