Sir: We read with great interest the recent article entitled “Lower Limb Reconstruction Using the Islanded Posterior Tibial Artery Perforator Flap,” by Dr. Mark Schaverien et al.1 We congratulate the authors on their article, which provides a review of the anatomy, their surgical technique, and indications for use of the posterior tibial artery perforator flap. This article prompted a lengthy discussion among plastic surgeons at our institution. However, our review of lower limb anatomy differs slightly from that described by the authors in this article. In 1997, the posterior tibial artery perforators and their fasciocutaneous territories were described by Whetzel et al.2 A number of studies have described the lower limb arterial supply, including the anterior tibial, peroneal, sural, and posterior tibial artery perforators. Schaverien and Saint-Cyr published a detailed anatomical study of the lower extremity perforators using arteriovenous latex cure and cadaver dissection in 1998.3 In this article, the authors describe the posterior tibial artery perforators as “arising from within the intermuscular septum between the soleus and the flexor hallucis longus.” According to our review of the above studies and anatomy textbooks, the posterior tibial artery traverses the deep posterior compartment of the lower leg. The posterior tibial artery perforators and their two associated venae comitantes pass through two intermuscular septae: between the soleus and flexor digitorum longus; and the medial aspect of the tibia and the flexor digitorum longus (not the flexor hallucis longus, which lies lateral to the posterior tibial artery).2–5 The islanded posterior tibial artery perforator flap does seem to be a reliable, versatile fasciocutaneous flap for use in reconstruction of lower limb soft-tissue defects. However, as with any flap, it is vital to have accurate knowledge of the vascular and musculoskeletal anatomy of the flap and surrounding tissue before proceeding with such an endeavor. In addition, it would be interesting to determine whether there are any differences in complication rates based on the location of injury (e.g., lower leg, ankle, heel). Megan C. Jack, M.D. Martin I. Newman, M.D. Department of Plastic Surgery Cleveland Clinic Florida Weston, Fla. Yoav Barnavon, M.D. Hollywood Memorial Hospital Hollywood, Fla. DISCLOSURE The authors have no financial interests with respect to the content of this communication or the article being discussed.