Distally based sural fasciomuscular flap: Anatomic study and application for filling leg or foot defects

Since 1995, the authors have created 32 distally based superficial sural ar tery flaps based on the vascular axis of the sural nerve. The creation of t he first 18 flaps permitted the authors to view perforators that issued fro m the gastrocnemius muscles to the vascular axis of the sural nerve. This l ed to the development of an anatomic study involving 25 cadaveric dissectio ns to establish a relationship between the gastrocnemius muscles and the va scular axis of the sural nerve, with two to three constant and direct perfo rators from the gastrocnemius to the neurovascular axis. In this article, t he technique for harvesting this new muscular flap is described. Between June of 1997 and March of 1998, three patients underwent flap opera tions. Two fasciomyocutaneous flaps and one fasciomuscular flap were create d and were followed by uncomplicated postoperative courses in terms of flap viability and donor sites. In all cases, the flap created was designed to fill bone defects of the leg tone case! or of the foot (two cases). The res ults were considered to be excellent and stable over time, with follow-up p eriods ranging from 9 months to 18 months in duration.