[The nutrient flap. Its application in saving lower limbs involved in stage IV arteritis]

The skin covering role of the nutrient flap is only accessory. However, this role is essential for an ordinary flap. In stage IV arteriosclerosis of the lower limbs when classical revascularization techniques cannot be performed, the nutrient flap can be spread over the distal extremity of the limbs. It provides a supplementary blood flow to ischaemic zones and it induces the neoformation of a vascular network. The nutrient flap avoids the need for high amputation and preserves weight bearing by maintaining the heel. Four clinical cases are detailed and the surgical techniques are described. The flap usually raised from latissimus dorsi, is anastomosed to the popliteal artery by means of an inverted saphenous vein graft, and is spread over the extremity of the limb after a wide excision of all the necrotic tissues.