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Background:Reconstruction of soft-tissue defects in lower third of leg, ankle, and foot has been a challenge and reconstructive surgeons have been trying to innovate different flaps. To solve this issue, we propose a distally based sural artery peroneus flap (DBSPF) in which we include superficial portion of the peroneus brevis muscle and its blood supply with the peroneal artery distally. The aim of this study was to evaluate the functional outcome and its usefulness over conventional distal sural artery flap or other local options available.Methods:This is a case series of 20 patients that include a DBSPF that was done for defects around ankle, distal leg, and foot caused by trauma or tumor ablation within the period of June 2013 to March 2015 in Kasralainy Hospital, Cairo. All cases were evaluated according to flap vascularity, distal reach of flap, aesthetic outcome, and donor-site morbidity.Results:All flaps survived. One flap developed venous congestion that subsided spontaneously with limb elevation. The flap dimension ranged from 42 cm to 442 cm2, and it reached the midfoot easily. The pivot point was kept as low as 2–6 cm from lateral malleolus according to location of perforators. The ankle stability was maintained, and the desired aesthetic outcome was achieved.Conclusions:The DBSPF is an addition to the armamentarium in plastic surgery for defects around ankle, distal leg, and foot. It is an easy and swift procedure as compared with complex microsurgical reconstruction.

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Scalp avulsion injuries are usually attributed to entrapment of long hair or clothing in agricultural or industrial machinery or traffic accidents. Though rare, these injuries may be dangerous, and resulting cosmetic defect and alopecia lead to social stigma and poor self-esteem. Early intervention in the form of microvascular repair and replantation prevent morbidity and improve outcome. In this case series, we have discussed 3 cases of scalp replantation, 2 complete and 1 partial. Immediate microvascular reconstruction was planned in each case. Single surgical team approach was followed, vessels were identified and operated under an operative microscope. No vein grafts were used. Operative outcome was good, and scalp healed well. Cosmetic outcome was excellent, and there was no need for secondary revisions or use of tissue expanders. Immediate referral of such cases to institutes with facility for microvascular repair is recommended to reduce ischemia time. Superficial temporal artery is the first choice for microvascular repair in scalp replants, and a single artery anastomosis is sufficient to perfuse the entire scalp. Deep temporal artery is a viable alternative in cases where repair with superficial temporal vessels will require use of vein graft, cutting short operative time and associated complications.

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