The distally based superficial sural artery flap, first described as a
distally based neuroskin flap by Masquelet et al., is a skin island f
lap supplied by the vascular axis of the sural nerve. The aim of this
paper is to refine the surgical technique in order to establish the re
liability of this flap. We treated 20 patients with 21 distally based
superficial sural artery flaps, including 2 fascial flaps. All flaps s
urvived. Most flaps showed slight venous congestion. In the largest fl
ap (10 cm wide by 13 cm long), edema lasted 2 months. In the flap whos
e pedicle was raised without the deep fascia, there was necrosis at th
e distal tip of the flap. The advantages are the following: The blood
supply is reliable, elevation is easy and quick, and major arteries ar
e not sacrificed. This new flap may be useful in selected circumstance
s.