Soft-tissue defects following calcaneal fractures can be covered in a relat
ively easy and safe procedure. We have modified the familiar distally based
sural artery flap by lifting a part of the gastrocnemius muscle. With an i
nferior pedicle, this musulocutaneous flap can be rotated onto the defect o
n the sole of the foot and on the heel. Five patients with open fractures o
f the calcaneus or wound necrosis after osteosynthesis were treated with th
is procedure. Two defects were covered uneventfully, two flaps were prepare
d, the rotation being done in a secondary procedure. One patient demanded f
urther revisions, and the flap was partially lost, but the remaining defect
was covered after open treatment. This new musculocutaneous sural artery f
lap can be used for covering even an extensive defect after calcaneal fract
ures and seems to be a reliable procedure. Morbidity at the donor site is l
ow, and in the case of failure, the free flap remains an alternative.