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The vascular pedicle of the flap includes an axial perforator branch of the peroneal artery and two concomitant veins. This modified distally based perforator flap, measuring around 17 \u00d7 6 cm to 30 \u00d7 10 cm in size, was transferred for coverage of foot and ankle soft\u2010tissue defects in 7 cases. All flaps survived completely. Neither arterial ischemia nor venous congestion was noted. As compared to other distally based sural flaps with neuro\u2010veno\u2010adipo\u2010fascial pedicles, this modified sural flap with a thin perforator pedicle is easily rotated. The flap can obtain abundant blood supply through both axial perforator and longitudinal chain\u2010linked vascular plexuses, and does not have the venous reflow problem. In conclusion, the invention of this perforator fasciocutaneous flap provides a valuable tool for repair of foot and ankle soft\u2010tissue defects. \u00a9 2004 Wiley\u2010Liss, Inc. 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