Reversed Sural Island Flap Supplied by the Lower Septocutaneous Perforator of the Peroneal Artery

In Brief The current study was conducted to document the vascular anatomy of the distally based superficial sural artery flap and to study the vascular anastomoses between the superficial sural artery and the septocutaneous perforator of the peroneal artery. Five fresh human cadavers were injected with lead oxide, gelatin, and water. Ten legs were then dissected and an overall map of the cutaneous vasculature by source vessel was constructed. Vascular communication between the superficial sural artery and the lowest septocutaneous perforator of the peroneal artery was evaluated to determine the cutaneous vascular territory of the superficial sural flap. This anatomic information enhances our understanding of flap design. The authors’ clinical experience with the usefulness of the distally based island flap as a method of reconstruction in the lower leg and foot in a series of 26 patients is presented. An injection study of 10 fresh human cadaver legs demonstrated a constant vascular anastomosis between the superficial sural artery and the lowest septocutaneous perforator of the peroneal artery 4 to 7 cm proximal to the lateral malleolus. Twenty-six distally based superficial sural flaps supplied by this perforator were successfully transferred to cover defects of the heel, malleolus, distal third of the leg, and dorsal foot.