Achilles' region reconstruction with a sural neurocutaneous flap

The Authors present two case reports of tissue loss of the Achilles' region following injury. Repair was obtained in both cases by means of a neurocutaneous flap based on the satellite blood supply of the sural nerve. The flap is raised from the posterior aspect of the thigh, between the upper and median thirds where the sural nerve penetrates the deep muscle fascia; the nerve runs then subcutaneously until the lower third. The upper edge of the skin island is at the muscle and tendon junction point of the two parts of the gastrocnemius muscle. The arterious flow is of the reverse type and is provided by vascular connections between the sural and peroneal arteries. The most distal of such anastomoses is at the tibial malleolus and is also the rotation point of the flap. The flap vascular pedicle must include both subcutaneous tissue and fascia accompanying the sural nerve, the arterial branches supplying the nerve and the sural vein. This method has proved to be most versatile, the skin island obtained was large enough to cover satisfactorily the losses of tissue in both patients, the rotation are allows easy reaching of the most distal part of the leg, repair is achieved without damaging major vessels and/or muscles of the lower limb.