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The reverse sural artery flap is a fasciocutaneous flap based on the median superficial sural artery and its communication with the perforating branch of the peroneal artery situated in the region of the lateral malleolar gutter. Reverse flow is established after elevation of the flap and with division of the sural artery and the nerve proximally. The authors present resurfacing of acute open fractures of the lower third of the leg in 7 patients immediately after the acute phase of injury. Reconstruction was carried out within an average of 3 days after injury. All 7 patients sustained low-velocity injuries. Although 2 patients had partial necrosis of the distal tip of the flap, all patients had excellent recovery with minimal donor site morbidity.

Thumb duplication is a common congenital abnormality accounting for 6.6% of all hand deformities. The object of the primary surgery is to achieve a thumb with aligned joint surfaces and epiphyses perpendicular to the long axis, central flexor and extensor tendons, and adequate collateral ligaments. Experienced surgeons with an understanding of the abnormal anatomy and knowledge of the numerous refinements in technique cannot guarantee a flawless result. Of 43 cases treated in this Unit during the period 1970-1989 49% were noted to have secondary deformities. Angulation at the IP and/or MP joints were the most commonly observed problems. Unsatisfactory results were seen with a greater frequency following correction of the more complex deformities.

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