The skin in this region is nourishe

The skin in this region is nourished by what Manchot called the lateral, medial, and median SSAs7 (which correspond to arteria saphena palva),8 gastrocnemius muscle perforators, and other septocutaneous perforators derived from the sural artery, the posterior tibial artery, or the peroneal artery. The SSAs are derived directly from the popliteal artery, the lateral or medial sural artery, or the other genicular arteries and run inferiorly along the medial or lateral cutaneous sural nerve. The medial and lateral heads of the gastrocnemius muscle are nourished primarily by a medial and lateral sural artery, respectively, and most of theperforators that run though the gastrocnemius muscle originate from these sural arteries. Some perforators arise from the posterior tibial artery or the peroneal artery. We have found through our previous anatomic study and clinical experience that communication existsamong these SSAs, the medial gastrocnemius muscle perforating arteries, the perforators from the lateral head of the gastrocnemius muscle, and other perforators.2,6 Such findings indicate that an arterial flap with or without a vascularized sural nerve can be elevated basedon either an SSA or gastrocnemius perforator because of the rich anastomoses described above