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Abstract Objective To explore the anatomical basis and clinical application of distal sural neurovascular flap with downward shift of rotation point.Methods Five cases of superior knee amputation were perfused with latex barium sulfate solution through the thigh artery.The origin，distribution，quantity and outer diameter of the perforating branch of the fascia near the posterolateral muscle septum of the leg were dissected and examined by X-ray.From January 2013 to September 2018，22 cases of distal sural neurovascular flap were used，they were 20 males and 2 females，and they aged 3 to 70 years with an average age of 43 years.The size of the flap was 6 cm×5 cm～14 cm×11 cm，the rotation point was 2~5 cm above the lateral malleolus，and the wound size in the recipient area was 5 cm×4 cm~13 cm×10 cm.Results The lateral calcaneal artery was 2.1 cm and 4.0 cm on the lateral malleolus，and 2 skin branches were sent out at，and the external diameter of the vessels penetrated into the deep fascia was 0.5~0.8 mm.In this group，14 cases were completely alive，8 cases were partial necrosis，and the necrotic area was about 1 cm×1 cm～1 cm×3 cm，which was cured after dressin.Conclusion The flap blood supplyis reliable，flexible to design，safe in surgical heavest and suitable for repair leg and skin and soft tissue of the foot and ankle wounds.It is worthy of clinical promotion.
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