Increasing Versatility of the Distally Based Sural Flap

Keçeci, Yavuz; Sır, Emin

doi:10.1053/j.jfas.2012.05.018

Cited by 15 publications

(14 citation statements)

References 34 publications

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“…[ 14 – 16 ] Moreover, the skin-bridge provides not only protection from the pedicle twitching, twisting, or compression, but also a safe handling of the flap at the time of transfer. [ 17 ] In all of our cases, we maintained a full-thickness skin-bridge at the pivot point, thereby achieving complete survival of all flaps without any postoperative venous congestion. We can also reduce the need for postoperative flap monitoring.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of freestyle perforator-based peninsular flaps

Yoon

Kim

et al. 2018

Medicine

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This study aimed to present a simple, fast, and safe technique, called freestyle perforator-based peninsular flap (FPBPF), for pressure sore reconstruction.Among the 21 patients who underwent pressure sore reconstruction between May 2013 and October 2016, 12 patients (Group A) and 9 patients (Group B) were subjected to perforator-based island flap (PBIF) and FPBPF, respectively. We retrospectively reviewed and statistically analyzed the data of both groups.All flaps completely survived in both groups. No significant differences were found in patient demographics, complications, hospital stay, and follow-up period. The mean arc of rotation (102.50 ± 17.645° vs 83.33 ± 14.142°; P = .01), mean flap harvest time (35.83 ± 2.552 minutes vs 20.88 ± 1.763 minutes; P < .001), and mean operative time (145.41 ± 6.788 minutes vs 131.66 ± 10.770 minutes; P = .002) were significantly decreased in Group B compared with Group A.The FPBPF is a simpler and faster technique than the PBIF. FPBPF is a good modality with a few complications for sore reconstruction.

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Section: Discussionmentioning

confidence: 99%

Retrospective study of freestyle perforator-based peninsular flaps

Yoon

Kim

et al. 2018

Medicine

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“…3 Dissecting off the sural nerve could damage sural flap circulation because of the dense interconnection between the vascular structures and the nerve. 4 Although including the sural nerve in the flap may cause the disturbing sensory loss, an adequate blood supply as well as flap survival are more important to patients with chronic wounds. Hence, in all of our cases we included the sural nerve in the flap, resulting in only one patient who complained of the related numbness.…”

Section: Discussionmentioning

confidence: 99%

Experience with the Distally Based Sural Neurocutaneous Flap for Ankle and Heel Wounds

Sin-To

Chan

Lau

2016

Journal of Orthopaedics, Trauma and Rehabilitation

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a b s t r a c tBackground/Purpose: Soft tissue loss over the ankle and heel is a challenging issue for reconstructive surgeons. The aim of this study is to present the technique of using sural neurocutaneous flap and analyse the results. Methods: From 2002 to 2014, 15 cases of sural flap were performed in the Department of Orthopaedics and Traumatology of United Christian Hospital, Hong Kong. All cases were handled by two hand surgeons. The outcomes and complications were reviewed retrospectively. Results: The aetiology included trauma (6 cases), neoplasm (4 cases), Achilles tendon repair wound complication (3 cases) and ulcer (2 cases). The age of patients ranged from 21 years to 82 years (average, 61.9 years). The size ranged from 12 cm 2 to 99 cm 2 . The mean follow-up period was 20 months. Eleven flaps healed successfully without significant complications. Conclusion: Sural neurocutaneous flap is a reliable flap design with constant vascular anatomy. There is minimal donor site morbidity, and no major vessels are sacrificed. It provides a durable, pain-free, functionally and aesthetically satisfying coverage for ankle and heel wounds.

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“…This time frame can be modified based on the pathophysiology and patient population, delaying for a longer time period in more challenging pathology and significant comorbidity history [8]. Furthermore, the utilization of a wider, more pronounced pedicle and its benefits regarding flap viability have been documented in the literature [9,10]. We feel that no less than 3 cm in a narrow island pedicle flap should be utilized and suggest a 4 cm pedicle whenever possible to increase venous outflow and perfusion of the flap.…”

Section: Why Delay?mentioning

confidence: 99%

Cadaveric Atlas: Reverse Sural Flap Delayed Technique, A Novelty Approach to Stepwise Algorithm Utilizing Skin Substitute Bilayer

Vazales¹,

Rodriguez-Collazo²,

Thioné

2018

International Journal of Orthoplastic Surgery

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Indications The most common location for transposition of the reverse sural flap is to the posterior heel and distal lateral malleolus. However, this flap's versatility allows for the limits of its indications to be increased to include multiple areas of the posterior lower limb with small defects. Much of the literature has provided a discussion of noted reasons to undergo the harvest of the reverse sural flap which include traumatic injuries with soft tissue deficient, severe infections including osteomyelitis which requires both bone and soft tissue resection, failed surgical incisions, tumor resection and for defects to the posterior lower limb that are not amenable for treatment with a more common flap technique. Furthermore, the flap offers the surgeon an alternative to a free tissue transfer and low donor site morbidity. Completing a delayed harvesting technique, the flap is raised over a period of days to weeks insuring the viability of the tissue and may help to produce more successful outcomes that are also more reproducible by many different surgeons. The purpose of the delay technique is to improve vascularity and venous outflow to the pedicle prior to acute transposition. Contraindications Although the reverse sural flap has continued to gain popularity and utilization, its list of complete and relative contraindications to attempting harvest remain present. Complete contraindications are limited but include significant poor circulation, inability to reach the defect site given its arc of rotation of the flap, to large of a tissue deficit and if another flap with better indication can be utilized. Relative contraindications continue to evolve as modifications to the technique improve functionality. Relative contraindications for the reverse sural flap have included patients with one or several of the following comorbidities: history of smoking, current smoker, obesity, diabetes, peripheral vascular disease, venous insufficiency/venous outflow disease and old age [1, 2, 3]. Older literature suggests up to 36% complication rate in these patient populations [1]. More recently, this data was supported further, identifying statistically significant increases in both major and minor reverse sural flap complications in patients with one or multiple noted comorbidities when compared to patients with no comorbidities. Smoking alone was noted to be the most significant independent risk factor for flap necrosis and ultimate failure [4]. One other relative contraindication is in those patients that are extremely high risk for limb loss. In these scenarios, alternative options must be contemplated by the surgeon as a posterior gastrocnemius flap would be required should a below knee amputation be indicated. In higher risk patient populations, a delayed technique for harvesting of the graft should be considered.

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Increasing Versatility of the Distally Based Sural Flap

Cited by 15 publications

References 34 publications

Retrospective study of freestyle perforator-based peninsular flaps

Retrospective study of freestyle perforator-based peninsular flaps

Experience with the Distally Based Sural Neurocutaneous Flap for Ankle and Heel Wounds

Cadaveric Atlas: Reverse Sural Flap Delayed Technique, A Novelty Approach to Stepwise Algorithm Utilizing Skin Substitute Bilayer

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