Coverage of lower extremity distal defects with distally based superficial sural artery island flaps: Anatomical and clinical considerations

Defects in the distal part of the leg are very difficult to cover and remain a challenge for the plastic surgeon. The literature reports many possible reconstruction options to solve this problem including skin grafts, local flaps, cross-leg flaps, and free flaps; the ideal flap however, should not depend on microsurgery and should not sacrifice any major artery or sensory nerve. A valid solution for the coverage of lower extremity defects is a distally based fasciocutaneous flap that permits the lost tissue to be replaced with tissue of the same kind which also represents a good compromise between aesthetical and functional results and a rapid and simple technique. The authors emphasise the importance of the vascular supply from the accompanying arteries of the lesser saphenous vein and their preference to leave the skin island above the pedicle in order to minimize the compression. The ligature of the lesser saphenous vein at the height of the pedicle avoids venous congestion.