Distally based sural island flap for foot and ankle reconstruction.

The distally based sural island flap is vascularized by the cutaneous perforating branches of the peroneal artery. Three variants of this flap were used for reconstruction of 19 patients with defects in the ankle and in both dorsal and plantar surfaces of the foot. Four adipofascial sural flaps were used to cover the exposed Achilles tendons. Twelve fasciocutaneous sural flaps were used to resurface defects in the ankle region as well as in the non-weight-bearing area of the heel. Another four sural flaps, innervated by the lateral sural cutaneous nerve, were used to resurface the weight-bearing areas of the heel. The advantage of this flap is a constant and reliable blood supply without sacrifice of major arteries or sensory nerves. It also has the potential for reinnervation and can be performed in a single stage without microsurgery.