[Double use of sural fascio-cutaneous flap with distal pedicle to cover loss of substance of ankle or heel].

The authors report on a case of a distally based fascio-cutaneous flap from the sural region which has been used twice to cover two different cutaneous sites of an ankle. A 50 years old patient underwent a polytrauma including an open fracture of the ankle. The wound at the anterior aspect of the ankle did not heal and the cover by a distally based fascio-cutaneous sural flap was decided and realized successfully. Three weeks later, owing to the development of an ulcer of the heel, it was decided to cover this skin ulceration with the same distally based flap. This second procedure needed a complementary dissection at the bottom of the flap. Twenty days later, the remaining flap was put back and the uncovered donor site was skin-grafted. The two sites covered by the flap healed, without any further complications. They only benefited in the following months of plastic revision to improve their shapes. In the discussion the authors remind the anatomic basis of this distally based flap, described by Donsky and Fogdestam in 1983. They also discuss the other possibilities to cover these two lesions on the same ankle, using others flaps particularly the lateral supra malleolar flap described by Masquelet, the medial plantar island skin flap described by Harrison and Morgan, the lateral calcaneal skin flap described by Grabb and Argenta and the neuro-vascular island skin flap proposed by Masquelet et al. This clinical case emphasizes on the great interest of the distally based sural flap in the cover of the skin defect of the ankle. The flap is easy to raise and offers a great available skin surface, which can be used, as demonstrated by this original case, in two different sites of the ankle.