The limiting factor for their use is that most of reliable flaps can be used to cover upper two thirds of the leg and the available flaps for the lower third like soleus muscle and local muscle flaps have a limited values. The emergence of microvascular techniques paralleled the development of the operating microscope, microinstruments and sutures so the ability to transplant a flap to a distant site eliminated the necessity to select a flap with an arc of rotation that reaches the defect. This allows the transfer of composite tissue based on flap suitability for defect coverage rather than proximity to the defect.