www.PRSgo.com 1

Developments in surgical, medical, and reha-bilitation methods have greatly increased attempts and success rates of lower limb re-construction; not surprisingly, this has decreased the number of primary posttraumatic amputations. Nev-ertheless, there is still a defined niche for the very long posterior tibial artery (VLPTA) flap as long as the sole of the foot and the posterior tibial neurovas-culature are uncompromised. Such instances might include cases of extensive soft tissue, neurovascular, and bony injuries, which would necessitate immedi-ate or early amputation. Lengthy hospitalization and issues of patient compliance may make limb recon-struction inappropriate in certain patients with men-tal illness or learning disability. Lastly, the VLPTA flap should be considered in those with failed limb salvage secondary to complications such as osteomy-elitis, nonunion, or malunion of bone. METHODS In all 3 case reports, approximately 10 cm of tibia was preserved, which is optimal length for fixation and fitting of lower limb prostheses. The intrinsic foot muscles and the sole of the foot were harvested with subsequent proximal dissection of the posterior tibial neurovascular pedicle. The heel pad was then secured over the anterior aspect of the tibia and any remaining areas of soft tissue deficit were covered with a split skin graft. Russel et al1 accurately review the anatomy and precise technique of flap elevation