Use of distally based superficial sural island artery flaps in acute open fractures of the lower leg.

The reverse sural artery flap is a fasciocutaneous flap based on the median superficial sural artery and its communication with the perforating branch of the peroneal artery situated in the region of the lateral malleolar gutter. Reverse flow is established after elevation of the flap and with division of the sural artery and the nerve proximally. The authors present resurfacing of acute open fractures of the lower third of the leg in 7 patients immediately after the acute phase of injury. Reconstruction was carried out within an average of 3 days after injury. All 7 patients sustained low-velocity injuries. Although 2 patients had partial necrosis of the distal tip of the flap, all patients had excellent recovery with minimal donor site morbidity.