Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.322
Peer-review started: January 16, 2015
First decision: January 28, 2015
Revised: February 11, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: April 18, 2015
Core tip: Distally based perforator sural flaps are perfused by a perforating artery issued from the deep peroneal or posterior tibial artery, and the longitudinal chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable rapid procedure for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. This paper presents the developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.