The safety and reliability of the fasciocutaneous flaps are well confirmed and their use should be encouraged for the appropriate indications. The anatomic knowledge of the intermuscular posterior tibial perforators, also known as septocutaneous vessels, allows one to design a medial fasciocutaneous flap, distally based, very useful for soft tissue reconstructions in the lower leg, ankle and foot. The limiting factor is that the lowest septocutaneous vessel usually arises about 4,2 cm (range 2,5 cm – 5,0 cm) above the medial malleolus.

Sixty seven patients were treated with the medial distally based fasciocutaneous flap of the leg, from May 1984 to May 2002, including 52 males and 15 females. The average patient age was 36,1 (age range, 5 – 71 years). This flap was used for the treatment of soft tissue defects due to trauma (46 cases), osteomyelitis (7 cases), unstable scar (7 cases), chronic ulcer (3 cases), pressure sore (1 case), burn (1 case), burn scar (1 case), squamous cell carcinoma (1 case). The reconstructed areas were the upper third of the leg (5 cases), the middle third of the leg (11 cases), the lower third of the leg (17 cases), medial malleolus (8 cases), lateral malleolus (3 cases), heel (9 cases), dorsum of the foot (12 cases), plantar area of the foot (2 cases). The donor area was skin grafted in the great majority of the cases. All the flaps survived except for three cases with total necrosis and five with partial necrosis. All the other flaps healed uneventfully. The follow-up period was on average 36 months. This flap proved to have good durability even in ambulatory patients.

This flap is a reliable, versatile and simple reconstructive option wich can be performed within a short operative time. It is definitively an option to consider in reconstructive surgery of the leg and foot.
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