Reverse sural artery flap

The reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel. This flap is based on perforators of the peroneal artery system. The flap consists of superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery. A skin island may be demarcated at any point along the distal lateral leg containing the lesser saphenous vein and sural nerve on its central axis. The distal dissection is located 5 cm above the lateral malleolus to preserve the peroneal artery. The flap may be fashioned as a delay procedure to redirect blood flow and decrease the risk of flap necrosis. Additionally, may be supercharged by anastomosing the proximal end of the lesser saphenous vein to a recipient site vein to improve venous outflow. Finally, gastrocnemius muscle relies on superficial sural artery perforators and may be included for additional bulk. Flap complications include partial or total flap necrosis, hematoma, infection, and delayed wound healing.