The sural compendium: reconstruction of complex soft-tissue defects of leg and foot by utilizing the posterior calf tissue.

The posterior calf tissue can be used both in an antegrade and retrograde manner based on the neurovascular axis of the sural nerve, short saphenous vein, and its accompanying arteries for reconstruction of the lower limb. We present a simple algorithm for reconstruction of knee, leg, ankle, heel, and foot with sural flaps. During a period of 9 years (January 2002 to December 2010), reconstruction of the lower limb with different varieties of sural flap was performed on 168 patients. The ages of patients ranged from 4 to 75 years. Of 168 flaps, 154 survived completely, 9 flaps suffered partial necrosis, while 5 failed completely. Delay procedure was used on 67 patients. The sural flap can be considered as the workhorse flap and can be used in different ways to deal with myriad of clinical situations in which soft-tissue coverage becomes challenging.