Distal lower leg local random fasciocutaneous flaps.

Significant open wounds of the distal third of the lower leg that require some form of vascularized flap have historically been covered with distant cross-leg flaps or more appropriately with microsurgical tissue transfers. The rediscovery of the "random" fasciocutaneous flap as a reliable single-stage option for proximal lower leg defects has been extended distally to allow an expedient alternative in lieu of these more complicated procedures. Over the past 7 years, 17 selected patients had closure of distal leg and ankle wounds with 19 local antegrade-oriented fasciocutaneous flaps. All eventually healed without serious sequelae, although 5 (26 percent) had minor complications, except for one case that could only be salvaged with a free-tissue transfer in order to prevent limb amputation. For small- or moderate-sized, uncontaminated injuries, this approach warrants consideration under appropriate circumstances as a simpler option that may permit satisfactory healing and avoids the known risks of microsurgical tissue transfers.