Anatomical studies and five years clinical experience with the distally based medial fasciocutaneous flap of the lower leg.

Anatomical dissections, dye studies and clinical experience with the highly versatile inferiorly based medial lower leg fasciocutaneous flap, originally described by Amarante et al., have been described. Clinical uses include cover of the lower half of the tibia, foot and tendo achilles. Variations of the flap are described. The flap has been used in 42 clinical cases with only 2 failures and 2 partial failures. The dissection of the flap is quick and simple and the perforators reliable. The flap has obviated the need for a free flap in many of the cases, thus increasing the turnover in a busy unit. Dye injection studies and clinical experience have alerted us to the random nature of the flap in the proximal segment as described by Amarante. In high risk patients we modify the design.