The arteries adjacent to the lesser saphenous vein and sural nerve were investigated in 10 fresh cadavers that had been systemically injected with a lead oxide-gelatin mixture. The accompanying arteries were found to lie along the lesser saphenous vein and sural nerve and to nourish the skin through venocutaneous and neurocutaneous perforators. On the basis of the anatomy of these accompanying arteries, the lesser saphenous venoadipofascial (VAF) pedicled fasciocutaneous flap and the lesser saphenous-sural veno-neuro adipofascial (V-NAF) pedicled fasciocutaneous flap have been developed and applied to 23 cases of various reconstructions of the lower extremity with proximal and distal bases. Survival of the flaps has been extremely good, and the flaps have been clinically useful.