Delayed distally based sural flap with temporary venous supercharging

Abstract

The distally based sural flap has become popular for reconstruction of the foot and leg. However, this flap often fails due to venous congestion. In this report, we developed a new modification of the distally based sural flap. The procedure comprised three stages. In the first stage, the flap was raised cephalad to the midpoint of the posterior aspect of the leg, involving reanastomosis of the short saphenous vein (SSV) at the proximal end of the flap. In the second stage, ligature of the SSV was performed. In the third stage, the entire flap was raised. We treated eight patients with the flap. All flaps survived completely. Duplex scanning indicated that venous drainage of the flap was provided by the tenuous venae comitantes (VCs) surrounding the SSV. Reanastomosis of the SSV may prevent rapid venous overloading of the VCs. Our new modification may be useful to avoid venous congestion.

Supercharging of delayed pedicled transverse rectus abdominis myocutaneous flaps, is it a viable option?

“…It has been used with pedicled TRAM breast reconstruction since 1987. 11 Supercharging has been proven to augment venous drainage of sural flaps as well as enhance survival of free jejunal flaps with arterial insufficiency …”

Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: A prospective study

“…The concept of venous supercharging of pedicle flap is not new and has been reported by several authors using the TRAM flap (turbo and supercharge) (Sano et al, ), the sural neurocutaneous flap (Fujiwara et al, ; Tan et al, ), and the distally based ALT flap (Komorowska‐Timek et al, ; Lin et al, ). We also found reports on venous supercharging procedure for the free flaps, such as the DIEP flap, allowing a decrease of complications and failure (Boutros, ; Riot et al, ).…”

Distally Based Sural Artery Peroneus Flap (DBSPF) for Foot and Ankle Reconstruction

“…However, venous congestion and fixed flap dimension were the main limitations that attracted many surgeons to add further into it. Ayyappan and Chadha 11 used super-flap to shift the proximal limit near popliteal crease, 11 and others such as Tan et al 12 proposed single-stage supercharging of flap; Wong and Tan 13 used intermittent short saphenous phlebotomy, and Fujiwara et al 14 did temporary venous supercharging. A few surgeons included the gastrocnemius muscle beneath the fascia as described by Al Quattan, 15 Le Fourn et al, 16 and Mueller et al 17 in 2001 to further rectify it.…”

“…Some authors have used sural flap maximum to hind foot. 14 In our series, the maximum flap dimension exceeds 13 × 8 cm, and we have used it for midfoot defects because of its versatile design (Fig. 5).…”