Experience of 56 patients using a retrograde sural neurovascular flap to repair lower limb tissue defects

Abstract

This study was made to investigate the clinical effects of repairing lower limb defects with an improved retrograde sural nerve flap. From November 1996 to September 2010, a total of 56 patients with soft-tissue defects of the lower limb received improved retrograde sural neurocutaneous flap repair. There were 21 women and 35 men ranging in age from 12-73 years (average age 45.9). Eight patients had dorsal foot defects, five patients had foot bottom defects, four patients had heel defects, six patients had defects around the ankle, and 15 patients had defects below the lower third of the leg. Of these, 10 patients had exposed wounds and six cases had exposed tendons. The size of the surgical repair was between ∼6 cm × 5 cm and ∼25 cm × 9 cm. Four patients retained the donor's sural neurovascular flap and normal sural nerve function, and 10 patients retained the retrograde sural neurovascular flap with a thin layer of muscle. All grafted flaps survived in all 56 patients. Patient follow-up lasted between 3 months and 3 years. The shape and function of their lower limbs were satisfactory. Two-point discrimination detection in the donor area and nerve-control area revealed that the sensory function recovered well in the four patients with retained nerves. The partial necrosis of the distal flap in two patients healed successfully after dressing, and no other adverse reactions or complications were observed. Through clinical treatment of the 56 patients, good experience was accumulated. The operation methods made the flap blood supply more abundant, improved the survival rate, and retained the sensory function of the donor site of the lower limb flap. This reduced the damage to the donor site and made the operation safer.

Repeated reverse sural fasciocutaneous flap is an effective surgical strategy for repairing long segmental soft tissue defects of the tibia

“…11 Therefore, cultivation of granulation tissue followed by application of split-thickness skin grafts is not recommended for large areas of tibial exposure. 12 Sural fasciocutaneous flaps include sural nerve flaps, 13,14 sural neurovascular flaps, 15 sural flaps, [16][17][18][19] and sural fasciocutaneous flaps. 1,20,21 These flaps can be used either in the forward or reverse direction; when used in reverse, they are termed RSFFs.…”

Hemodynamics in Distally Based Sural Flaps for Lower Leg Reconstruction: A Literature Review

“…If high, the vein should be ligated at the distal pedicle base to reduce postoperative venous congestion and allow for a more flexible flap rotation. 38…”

“…If high, the vein should be ligated at the distal pedicle base to reduce postoperative venous congestion and allow for a more flexible flap rotation. 38 Distal ligation may also remove the potential contribution of venous return from the vasa vasorum in longer flaps and increase congestive edema. The lesser saphenous vein also has value in supercharging drainage.…”

“…42,45 This especially benefits remote coverage at the mid-to-far anterior or dorsal foot where tissue is tighter and poorly vascularized. 38,46 The territory of flap tissue that can be extended by the delay is variable and largely dependent on the number of adjacent anastomoses captured during harvest. However, this can be optimized by preoperative identification with Doppler ultrasound imaging.…”

Heel Reconstruction With Bipedicled Flap: A Salvage Procedure

“…Reverse sural artery and medial plantar flaps are the foremost popular ones among them. [18][19][20][21][22][23][24] In this study, we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed.…”