The sural muscle flap requires blood flow from which vessels?

• A. Anterior tibial perforators
• B. Posterior tibial perforators
• C. Peroneal perforators
• D. Fibular perforators

Answer: (C)

The sural flap is nourished by the perforating branches of the peroneal (fibular) artery. These distal perforators travel from the peroneal artery through the posterior-lateral leg into the skin and fascia, providing a reliable blood supply for a flap raised with the sural nerve and accompanying vessels. When the flap is rotated to cover distal defects, the perfusion comes from retrograde flow through these peroneal perforators, making them the essential source. Perforators from the anterior or posterior tibial systems do not reliably supply this flap, and the peroneal perforators are the consistent vascular link that allows the sural flap to survive in its distal position.