Sural flap for coverage of a soft-tissue defect of a leg with an occluded fibular artery: a case report.

Coverage of soft-tissue defects of the leg has improved with the discovery of new flaps. However, surgeons now have to deal with new lesions on top of previous reconstructive surgeries. We present a case of soft-tissue defect of the anterior lower third of the leg presenting 20 years after reconstructive surgery for an open fracture and its management. The anterior tibial and fibular arteries were occluded with a retrograde vascularisation of the fibular artery; this provided a perforator artery that we used as a pivot point for an atypical sural island flap with a good result at 6 months. This case challenges the classic contraindication of this flap in case of occluded arteries.