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An anatomical study of 30 cases has been performed on the vascularisation of the distal third of the antero-lateral compartment of the leg, with particular reference to the relations of the infero-lateral collateral artery of the anterior tibial artery, the perforating branch of the peroneal artery, and the antero-lateral malleolar artery. A fascio-cutaneous pedicle flap based on the infero-lateral collateral artery is described noting that the superior, anterior, and posterior limits are similar to those of the lateral supramalleolar flap of Masquelet. The inferior limit of this new flap is 15 mm distal to the site of emergence of the perforating branch of the peroneal artery. The advantages of this flap are; a large surface area for cover, antegrade vascularisation, and no significant vascular sacrifice. The distal half of the calf can be covered both medially and posteriorly as well as the proximal half of the dorsum of the foot, the medial and lateral arch areas, the perimalleolar region, and the region behind the Achilles tendon. The flap requires the presence of the infero-lateral collateral artery of the tibialis anterior which can be confirmed either peroperatively or preoperatively by angiography.

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