Distally-based sural flap for reconstruction of the lower leg and foot.

A distally-based sural flap was used in four patients with soft-tissue defects in the lower leg and foot. All flaps survived completely without venous congestion. To make safe use of this flap it is important to include both the sural nerve and the lesser saphenous vein in the flap. It also seems to be important to include the surrounding fatty tissues in the pedicle and to avoid compression at the point of its angulation. This flap has the advantages that it is quick and easy to raise, and the reconstruction can be done in a single operation. It is unnecessary to sacrifice the major arteries in the leg, although the sural nerve must be sacrificed. In general this type of reconstruction of the lower leg and foot is beneficial in cases similar to those presented here.