The medial sural MEDIAL GASTROCNEMIUS perforator free flap: an 'ideal' prone position skin flap.

The medial sural MEDIAL GASTROCNEMIUS perforator flap is a potentially large, thin cutaneous flap that encompasses the calf skin territory. Its medial sural vascular pedicle has a long leash of large caliber that simplifies microanastomoses when used as a free flap. Because the identification of the requisite perforators and their subsequent intramuscular dissection is facilitated with the patient in a prone position, this can be an "ideal" skin free flap for the posterior aspect of the body. This is especially true for the lower limb where all surgical morbidity could then be restricted to the ipsilateral extremity. This approach has been used in 5 clinical cases, with success except once when the flap was aborted as a result of anatomic anomalies, which is always a concern with muscle perforator flaps.