Salvage of the distal foot using the distally based sural island flap

The authors describe their additional experience with the distally based su ral island flap for reconstruction of the whole foot, including the forefoo t area in 8 patients. The flap is vascularized by the lowermost perforating branches of the peroneal artery. The skin flap can be elevated, based on t he lesser saphenous vein and its accompanying arteries, in all parts of the sural region. This modification allows a farther reach of the flap for cov erage of the distal foot and sole. All flaps, innervated by the lateral sur al cutaneous nerves, were able to provide protective sensation in the dista l soles. In 7 patients the flaps survived completely, and only 1 patient ha d partial necrosis of the flap. The advantage of this flap is its constant and reliable brood supply without sacrifice of the major artery. Elevation of the flap is simple and rapid. This flap is a versatile alternative that should be considered prior to a free flap transfer.