Background: Limb salvage rates for lower limbs have improved tremendously for trauma and tumor victims. The optimal solution for coverage of defects caused by ischemic limbs does not exist. The authors believe the use of supermicrosurgery and perforator flap surgery might add a further tool useful to the reconstructive surgeon. Methods: After excisional débridement of the wound, under loupe magnification, branches of the terminal foot vessels were sought. Once identified and deemed suitable, the thin peroneal flaps were isolated based on perforator vessels. The flaps raised were either peroneal perforator-based or soleus perforator-based flaps. Microanastomosis was performed at the perforator level with 10-0 or 11-0 Ethilon sutures, and the flap was inset. The donor site was closed primarily. Results: A total of 18 such flaps were raised in 17 patients with 15 septocutaneous and three musculocutaneous perforators. Sixteen peroneal perforator-based flaps and two soleus perforator-based flaps were used. There was one major (flap loss) and two minor (wound dehiscence) complications. The rest of the patients healed well, with no recurrence at a mean follow-up of 8.3 months. Conclusions: Limb salvage in ischemic limbs is now possible with supermicrosurgery and perforator flaps. This method allows contour resurfacing, avoids bulky tissue, is fast, and can be performed under regional anesthesia.