The Distally Based Superficial Sural Artery Flap

The distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. The aim of this paper is to refine the surgical technique in order to establish the reliability of this flap. We treated 20 patients with 21 distally based superficial sural artery flaps, including 2 fascial flaps. All flaps survived. Most flaps showed slight venous congestion. In the largest flap (10 cm wide by 13 cm long), edema lasted 2 months. In the flap whose pedicle was raised without the deep fascia, there was necrosis at the distal tip of the flap. The advantages are the following: The blood supply is reliable, elevation is easy and quick, and major arteries are not sacrificed. This new flap may be useful in selected circumstances.