Medial suralGASTROCNEMIUS muscle perforator free flap: an immediate cross-leg flap?

The advantage of the medial sural (GASTROCNEMIUS) muscle perforator free flap is that it is relatively thin, even in most obese individuals, and the donor site can be acceptable, if morbidity must preferably be restricted to the lower extremities. Unfortunately, anatomic anomalies of both the arterial and venous circulation are not infrequent, making this a somewhat less than perfect donor site in the author's total experience using this flap. Nevertheless, the contralateral calf skin was successfully used, as shown in a clinical example, to cover a transmetatarsal amputation stump. This allows the conclusion that, at least as a technical exercise, the medial sural (GASTROCNEMIUS) muscle perforator free flap as a microsurgical transfer can be used as an "immediate" cross-leg flap. This is reminiscent of bygone eras, where such a feat required multiple stages over many weeks.