Increasing the Success Rate of the Reversed-Flow Fasciocutaneous Island Sural Flap

El-Shazly, Mohamed; Yassin, Osama

doi:10.1097/01.sap.0000235475.74372.67

Cited by 16 publications

(14 citation statements)

References 17 publications

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“…Several studies have shown good results with the use of this flap [4][5][6][7][8][9][10][11][12][13] . Because several errors are common during the learning phase of this technique, describing these errors may improve the initial results and may support the continued use of this flap.…”

Section: Introductionmentioning

confidence: 99%

Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações

Vendramin¹

2012

Rev. Bras. Cir. Plást.

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Reverse flow sural flap: 10 years of clinical experience and changes Reverse-flow sural flap: 10 years of clinical experience and modifications Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações ABSTRACT Background: The reverse flow sural flap has been featured as a relevant option for reconstruction of the distal region of the legs and feet. However, some common mistakes are made while surgeons are learning how to employ this flap. The aim of this study was to analyze use of the flap by surgeons in with 10 years of experience by comparing the first 5 years to the last 5 years in order to identify technical alterations that contribute to better results. This study also aimed at alerting the surgeons in the learning phase regarding the most important details that should be addressed when using this technique. Methods: We studied the results obtained for 61 reverse flow sural flaps used from January 2002 to December 2011. The patients were divided into 2 groups: group 1, patients that underwent surgery from January 2002 to December 2006 and group 2, patients that underwent surgery from January 2007 to December 2011. In group 2, we made changes to the fasciocutaneous flaps that included dissection of a fasciosubcutaneous margin exceeding the cutaneous portion of the flap and preservation of a lane of skin over the pedicle. Results: In group 1, the incidences of partial necrosis and total necrosis were 18.5% and 3.7%, respectively, whereas group 2 had an 8.8% incidence of partial necrosis and no cases of total necrosis. Conclusions: The reverse flow sural flap is a good option for the treatment of the distal region of the legs and feet. Experience with this technique and the additional cautions described herein may contribute to even better results.

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Section: Introductionmentioning

confidence: 99%

Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações

Vendramin¹

2012

Rev. Bras. Cir. Plást.

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“…The medial plantar artery flap is commonly used for small wounds of the heel pad and ankle (Cohen et al, 1999; Duman et al, 2002; Gu et al, 2017; Khai Luen & Wan Sulaiman, 2017; Oh, Moon, Cha, Koh, & Chung, 2011; Scaglioni, Rittirsch, & Giovanoli, 2018; Schwarz & Negrini, 2006; Siddiqi, Hafeez, Cheema, & Rashid, 2012). For slightly larger or proximal defects, the reverse sural flap or propeller flaps are options (Benito‐Ruiz, Yoon, Guisantes‐Pintos, Monner, & Serra‐Renom, 2004; El‐Shazly & Yassin, 2006; Lu, Chai, Wang, & Wen, 2014; Maffi, Knoetgen III, Turner, & Moran, 2005; Xu & Lai‐Jin, 2008). However, large, complex wounds, often the result of trauma, can limit the availability of these locoregional options and usually require the use of free flaps for coverage.…”

Section: Discussionmentioning

confidence: 99%

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

et al. 2020

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Background The non‐weight‐bearing (NWB) Achilles tendon and weight‐bearing (WB) heel pad regions are technically challenging to reconstruct with distinct functional and aesthetic considerations that have not been previously considered in the literature. This study is the first to characterize the long‐term clinical and patient‐reported outcomes of these components to better inform patients about the postreconstruction period. Methods A retrospective review of medical records and phone‐based survey of adult patients who underwent free flap reconstruction of the heel/ankle with 6‐month minimum clinical follow‐up was performed. Results Forty‐three patients, with 31 (72.1%) NWB and 12 (27.9%) WB defects, treated from January 1, 2000 to February 28, 2017 were included. Muscle flaps were more common than fasciocutaneous flaps (N = 36 [83.7%] vs. 7 [16.3%]). Flap survival rate was 95.3% and limb salvage rate was 93.0% at median follow‐up of 12.0 months (interquartile range [IQR] 6.2, 25.5). Flap ulceration occurred more frequently in the WB region (41.7 vs. 6.5%, p = .0123). The survey response rate was 63.6%. The majority of patients complete daily tasks with no/little impairment (76.2%), walk half a mile or more (85.7%), returned to work (86.6%), and fit shoes “fair” or “well” (71.4%). Most patients were “very satisfied” with heel/ankle function (71.4%) and would “very likely” undergo the same procedure if needed (76.2%). Conclusions Free flap reconstruction in both the NWB Achilles tendon and WB heel pad has excellent limb salvage and flap survival rates. Patients were satisfied with heel/ankle function, but additional counseling is recommended for variance in appearance and higher ulceration rates in WB defects.

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“…The distally based neuro-fasciocutaneous flaps with blood vessel perforators are advantageous (Cavadas, 1997;Costa-Ferreira et al, 2001;Almeida et al, 2002;El-Shazly and Yassin, 2006;Afifi et al, 2008;Saint-Cyr et al, 2009) for lower limb reconstruction, especially for soft-tissue defects on the ankle and joints; however, necrosis of a part or most of the flaps usually occurs because of disturbances in venous drainage. To resolve this problem, several researchers have adopted the "anastomosed superficial venous method" in distally based neuro-fasciocutaneous flaps and designed interesting ways of transferring the flap to prevent pedicle distortion and compression.…”

Section: Discussionmentioning

confidence: 99%

Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels

Wang¹,

Cao²,

Huang³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The objective of this study was to introduce a method for repairing large soft-tissue defects on the foot. Distally based neurofasciocutaneous flaps with perforating vessels were designed along the saphenous and sural neurovascular axes. The cutaneous perforating branches of the major arteries of the lower extremities were used as pedicles, which provided a rotation arc for the cross-leg flap to cover the large-sized soft-tissue defects on the foot. We transferred 6 neurocutaneous vascular axial flaps, including 4 saphenous neurocutaneous axial flaps (ranging from 25 x 13 to 17 x 9 cm in area) with posterior tibial perforators as the pedicle, and 2 sural neurocutaneous axial flaps (ranging from 29 x 12 to 18 x 7 cm in area) supplied by the perforating branches of the peroneal vessels. These 6 cases of neuro-fasciocutaneous flaps survived with satisfactory cosmetic appearances and functional results on follow-up at 8 to 17 months post-surgery. Placing a distally based neurofasciocutaneous cross-leg flap with perforating vessels is an effective method for repairing large-sized soft-tissue defects on the foot.

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Increasing the Success Rate of the Reversed-Flow Fasciocutaneous Island Sural Flap

Cited by 16 publications

References 17 publications

Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações

Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels

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