The posterolateral malleolar flap of the ankle: a distally based sural neurocutaneous flap--report of 14 cases

The posterolateral malleolar flap is a fasciocutaneous flap designed on the principles of distally based neurocutaneous flaps. It is based distally at the level of the lateral retromalleolar gutter. Elevation of the flap involves the proximal sectioning of the sural nerve, which contributes to its vascularization by reversed flow. This is a very reliable flap, even in patients with distal arterial insufficiency. For this reason, it has emerged, in our experience, as the method of choice in the treatment of heel necrosis. Fourteen cases are reported, of which six were elderly patients.