Advancement V-Y flaps have been a popular choice for closure of deep wounds but their mobility is limited. Perforant based flaps are specially useful when greater advancement and bigger coverage are needed. We designed a gastrocnemius based flap that uses both techniques for covering the defects of the medial third of the leg. We follow a retrospective evaluation of 5 patients that had their wounds in the medial and superior third of the leg covered by an advancement V-Y gastrocnemius perforant based flap between January 2005 and September 2007. All were men, mean age 48 years and the ethiology was traumatic in all cases. The perforant vessel was evaluated by colour duplex preoperatively. All procedures were made by the same surgeon. Patient satisfaction was evaluated telephonically in late evolution. All vessels were found preoperatively, mean surgical time was 1.8 hours. No complications were observed; coverage was successful in all cases and there was complete satisfaction in the group. Mean follow up was 19 months. As a conclusion, we propose that advancement V-Y gastrocnemius perforant based flap appears to be a safe alternative in the closure of medial third leg defects in a one time surgery with good aesthetic and functional results.