Skin defect below the knee joint presents difficult problems, particularly, when combined with fractures, nonunion or osteomyelitis. Many procedures have been described to resurface the defects in this area. Common useful methods include skin graft, local randomized or island flaps and free flaps. But, arterial studies have demonstrated a relatively poor supply that attribute late healing of both soft and bony tissues in pretibial area. So most textbooks have advised against the use of local flaps in pretibial area below the knee for several decades. An anatomic study, which showed the role of the vascular axis which follows the superficial sensory nerves in supplying the skin, developed the concept of a neuroskin island flap. PURPOSE: To present a clinical experience of neuroskin island flaps based on the saphenous nerve.

From September 1995 to December 1997, a total 12 neuroskin island flaps supplied by the vascular axis of the saphenous nerve were performed to close defects in pretibial area below the knee.

All cases survived completely without any specific complications.

The neuroskin flaps based on the saphenous nerve are versatile and reliable and especially indicated for limited defects in the pretibial area below the knee joint which are not good indications for other better-known flaps.