Reverse sural flap cover within a ring fixator.

The ring fixator is an ideal apparatus to treat infected gap nonunion of the tibia and to correct deformity in multiple planes. However soft tissue problems may arise during transport and at docking. Although various options such as free flaps, neurocutaneous flaps, fasciocutaneous flaps and cross leg flaps are available for flap cover, this is always done prior to application of a ring fixator. The versatility of the sural flap in terms of coverage of leg defects, ease of performing flap cover as well as its reliability and safety is well known. We describe an alternate way of treating soft tissue problems which occur at the lower third of the leg while being treated on an Ilizarov frame. We describe the surgical procedure followed in raising the flap and its anterior transposition within the Ilizarov frame in two patients.