Influence of flap factors on partial necrosis of reverse sural artery flap

Wei, Jianwei; Dong, Zhonggen; Ni, Jiangdong; Liu, Lihong; Luo, Sanchuan; Luo, Zhuojing; Li, Zheng; He, Anbang

doi:10.1097/ta.0b013e31822a2f2b

Cited by 49 publications

(57 citation statements)

References 26 publications

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“…In a large study of 179 reverse sural artery flaps by Wei et al in 2012 it was observed that partial flap necrosis occurred in 11.2% of cases. They concluded that partial necrosis rate was significantly higher in the flaps with top edge locating in the upper 1/9 of the calf, in the flaps with length-width ratio (LWR) ≥ 5 : 1 and in the flaps with width of skin island (width) ≥ 8 cm [23]. The major disadvantage of this flap is the scarification of the sural nerve leading to anaesthesia of the lateral foot.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Thammannagowda

Ashish

Mudukappa

et al. 2014

ISRN Plastic Surgery

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Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Defects at this site will often require flap cover. Free flap is ideal for these defects and gives good results but with its own limitations. The reverse sural artery flap (RSAF) and distal peroneus brevis flap (DPBF) have gained popularity for lower third leg defects among surgeons. We did a retrospective study on 64 patients admitted between 2011 and 2013 with posttraumatic moderate size defects of lower onethird leg who underwent RSAFs and DPBFs. These patients were followed up in the immediate and late postoperative period for complications and outcome assessment. The average surface area covered by DPBF was 27 cm 2 and by RSAF was 38 cm 2 . Both flaps gave a good functional outcome. DPBF has better aesthetic appearance at donor site and recipient site, with the advantages of ease of surgery, speedy recovery, less hospital stay, and no donor site morbidity; DPBFs appear to be a preferred choice for moderate size lower third leg defects. RSAFs should be chosen over DPBFs for defects in medial malleolus and larger size defects.

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Section: Discussionmentioning

confidence: 99%

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Thammannagowda

Ashish

Mudukappa

et al. 2014

ISRN Plastic Surgery

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“…20 Reported necrosis (including partial and complete necrosis) rates of the flap ranged from 4.8 to 36.0%. 1,9,17,[20][21][22][23] In pediatric patients, the necrosis rate was reported to be 5% (1/20) by Koladi et al 13 and 12.5% (2/16) by Vergara-Amador. 14 In this study, there was no complete flap necrosis; partial necrosis rate was 13.2% (7/53, pediatric group) and 12.2% (18/148, adult group), and marginal necrosis rate was 3.8% (2/53) and 1.4% (2/148).…”

Section: Discussionmentioning

confidence: 92%

“…The topedge location, compared with other flap factors including the total length, width of the skin island, and length-width ratio, was a better parameter for the evaluation of the influence of flap factors on the complications in the children and adults. 17 In this study, the top-edge location in both groups was comparable, and all the flap surgeries were performed by the senior author (Z.G.D.). In summary, the patient, flap, and operator factors have minor interference with the comparative outcomes of the complications.…”

Section: Discussionmentioning

confidence: 99%

“…17 Perforators from the peroneal artery were detected and marked preoperatively by means of color Doppler ultrasonography in the majority of the patients. We first explore the perforators before incising the upper and bilateral edges of the skin island.…”

Section: Operative Techniquementioning

confidence: 99%

“…To describe the top-edge location of the flap, the posterior aspect of the lower leg was equally divided into nine zones, the first to the ninth zone from bottom to top. 17 The reconstruction outcomes were evaluated according to the criteria introduced by Boyden et al 18 The donor-site morbidities were evaluated according to the published assessment system. 19 …”

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confidence: 99%

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Distally Based Perforator-Plus Sural Fasciocutaneous Flap for Soft-Tissue Reconstruction of the Distal Lower Leg, Ankle, and Foot: Comparison between Pediatric and Adult Patients

Wei

Dong

et al. 2014

J reconstr Microsurg

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There are no large series comparing the distally based perforator-plus sural fasciocutaneous flap used in pediatric and adult populations. The flaps were divided into two groups: the children (patient's age<14 years) group (n=53) and the adults (patient's age ≥ 18 years) group (n=148). We compared flap-viability-related complications and their potential risk factors. In the patients with at least 12-month postoperative follow-up, the reconstruction outcomes, donor-site morbidities, and transitory and permanent swelling of the affected lower limb were compared. Partial necrosis, marginal necrosis, and overall complication rates were 13.2, 3.8, and 17.0% in the pediatric group, and 12.2, 1.4, and 13.6% in the adult group, respectively; the differences were not statistically significant (p>0.05). Incidences of hypertrophic scar and pruritus at the donor site were significantly higher, while incidence of transitory swelling of the affected lower limb was significantly lower in the pediatric group. This flap in children is similar to that in adults in the reliability.

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Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

et al. 2013

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In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. The patient selection and surgical refinement are discussed. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at the Chang Gung Memorial Hospital. The defects were located at the ankle (three cases), foot (two cases), and heel (six cases). Particular attention was paid to precise patient selection and surgical refinements. Patient selection was based on the lower limb vascular status by palpable distal pedal pulses and ankle brachial index ranging from 0.9 to 1.2. Surgical techniques were refined as precisely locating the perforators of peroneal artery, placing the skin paddle in upper third of leg for a distal region coverage, designing a 7-cm-wide adipofascial pedicle with a 2 cm skin paddle on it, preserving the mesentery structure of sural nerve and concomitant artery with or without including gastrocnemius muscles cuff, no tunneling when inset this flap and supercharging with lesser saphenous vein whenever needed. All the flaps survived completely. Only one patient required immediate anastomosis of lesser saphenous vein to local vein around defect in order to relieve the venous congestion during operation. Patients felt diminished but adequate recovery of sense of touch and temperature at the flap. Following the precise patient selection and surgical refinements, the modified reverse sural flap seemed to be a reliable and effective local flap for reconstruction of the soft tissue defects on ankle and foot.

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Influence of flap factors on partial necrosis of reverse sural artery flap

Cited by 49 publications

References 26 publications

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Comparison between Peroneus Brevis Flap and Reverse Sural Artery Flap for Coverage of Lower One-Third Leg Defects

Distally Based Perforator-Plus Sural Fasciocutaneous Flap for Soft-Tissue Reconstruction of the Distal Lower Leg, Ankle, and Foot: Comparison between Pediatric and Adult Patients

Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

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