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A common problem seen in the plastic surgery referrals for management of fractures of theleg is the loss of tissue cover over the tibia. This is probably due to the fact that the anterior border of tibiais subcutaneous and prone to loss of tissue following road traffic accidents. To solve this problem a largeamount of tissue is required which is mostly available on the posterior aspect of the leg. In order to movethis tissue without risk of necrosis the flap must be supplied by an adequate number of perforator vessels.Therefore we decided to study the anatomy of perforators of the sural artery along with the posterior tibialand peroneal system so that the anatomical basis of a combined flap may be defined.Materials and Methods: We performed cadaveric dissection in 20 legs to note the location of the proximaland distal most perforators arising from the sural, peroneal and posterior tibial arteries on the posterioraspect of the leg extending from the intercondylar line up to 8cm proximal to the medial an lateralmalleolus. The area of medial belly of gastrocnemius with the adjacent posterior tibial perforators wasdesignated as the medial flap and the area over lateral belly of gastrocnemius with adjacent peronealperforators was designated as lateral flap.Results: In the area defined as the medial flap we found an average of 2.5 perforators arising from themedial sural artery and 1.7 arising from the posterior tibial artery. In the medial flap the distal mostperforator was the posterior tibial septocutaneous perforator, which was at an average 23.3cm from theintercondylar line, around 6.8 cm farther away from the distal most medial sural perforator. In the lateralflap region we found an average of 1.7 lateral sural perforators along with 1.5 peroneal perforators. In thisflap the distal most perforator was the peroneal septocutaneous, at an average distance of 23.1cm distal tothe intercondylar line and at an average of 7.3cm further away

Anatomical study of perforators of posterior upper and middle third of leg to assess feasibility of combined gastrocnemius flaps