DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20190938

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Bhushan R. Patil, Chandrashekhar Wahegaonkar, Nikhil Agarkhedkar, Bharat Bhushan Dogra

Abstract


Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.

Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.

Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.

Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.


Keywords


Ankle soft tissue defects, Extended reverse sural artery flap, Reverse sural artery flap, Soft tissue defect coverage around foot

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References


Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg. 2006;59(8):839-45.

2. Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg. 2007;119(6):138e-148e.

Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg. 1992;89(6):1115-21.

Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Aiso S, Fujino T. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast Reconstr Surg. 1998;102(3):779-91.

Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Fukui Y, Miyasaka T, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg. 1999;103(1):104-20.

Karacalar A, Idil O, Demir A, Güneren E, Simşek T, Ozcan M. Delay in neurovenous flaps: experimental and clinical experience. Ann Plast Surg. 2004;53(5):481-7.

Tosun Z, Ozkan A, Karaçor Z, Savaci N. Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot. Ann Plast Surg. 2005;55(2):169-73.

Al-Qattan MM. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle "cuff" around the sural pedicle. Ann Plast Surg. 2001;47(3):269-74.

Kneser U, Bach AD, Polykandriotis E, Kopp J, Horch RE. Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast Reconstr Surg. 2005;116(7):1910-7.

Foran MP, Schreiber J, Christy MR, Goldberg NH, Silverman RP. The modified reverse sural artery flap lower extremity reconstruction. J Trauma. 2008;64(1):139-43.

Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg. 2002;110(7):1673- 9.

Zhang FH, Chang SM, Lin SQ, Song YP, Zheng HP, Lineaweaver WC, Zhang F. Modified distally based sural neuro-veno-fasciocutaneous flap: anatomical study and clinical applications. Microsurgery. 2005;25(7):543-50.

Ríos-Luna A, Villanueva-Martínez M, Fahandezh-Saddi H, Villanueva-Lopez F, del Cerro-Gutiérrez M. Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb. Injury. 2007;38(7):824-31.

Zink JR, Syed SA, Zahir K, Thomson JG, Restifo R. Transferring vascular territories from one axial pattern flap to another: a comparison of delay procedures. Ann Plast Surg. 1997;38(4):385-7.

Yang D, Morris SF. Comparison of two different delay procedures in a rat skin flap model. Plast Reconstr Surg. 1998;102(5):1591-7.

Belfkira F, Forli A, Pradel P, Guinard D, Moutet F. Distally based sural neurocutaneous flap: clinical experience and technical adaptations. Report of 60 cases. Ann Chir Plast Esthet. 2006;51(3):199-206.

Ayyappan T, Chadha A. Super sural neurofasciocutaneous flaps in acute traumatic heel reconstructions. Plast Reconstr Surg. 2002;109:2307-13.