Reverse Flow Sural Flap;

Abstract

Background:Soft tissues injuries at foot especially at heel expose the tendons, bones and especially joints, which leads to risk of infections and necrosis. These often result from trauma (spoke wheel), tumors, systemic diseases and their wounds such as venous ulcers and diabetic foot wounds. Surgical planning of these defects remains a challenge due to shortage of local scar free tissue and reliable blood supply. The current study is conducted to observe the purposeful benefits of reverse sural artery flap to cover wounds at dorsum of foot, ankle & heel.Study Design:Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery, Dr. Ruth KM Pfau Civil Hospital Karachi.Period:January 2015 to January 2018.Material & Methods:All patients who presented with wounds at heel, dorsum of foot, and exposed calcaneus or Achilles tendon were included. A peroneal based perforator identified by hand held Doppler, a superficial vein, and the sural nerve were included in the pedicle. Patients were followed during the first 6 postoperative months. Postoperative outcomes like flap congestion, tip necrosis and flap failure were noted. Results:Total of 36reverse low sural flaps were done for the soft tissue coverage of the 24 heel defects, 8 ankle defects and4 dorsum of the foot defects. Twenty eight patients were male and eight were females and age ranged from 6 to 36 years (mean 21). Partial flap failure was seen in 3 cases and complete flap failure in 2 cases. There were no serious donor site complications and all patients were satisfied with the functional and aesthetic outcome postoperatively.Conclusion:Reverse sural artery flap is very suitable in providing soft tissue coverage of the wounds of heel and dorsum of foot. Harvesting sural flap is dependable and safe as it does not ends in any major postoperative donor site morbidity.

Reverse sural flap for anteromedial ankle and dorsal foot soft-tissue defect following an injury: A case report

“…Skin grafts are easy and quick to cover open wounds but cannot be applied to cover bare tendons or bone. Likewise, local flaps of the distal third of the lower extremity have a limited range of motion and arc of rotation [ 3 , 7 , 8 ]. Free flaps are an acceptable but complex reconstructive option [ 1 ].…”

“…Free flaps require long operative time, special instruments, and microsurgical training and are costly. These factors need consideration while choosing reconstructive options at many centers, especially in developing countries with limited health infrastructure [ 7 , 9 ].…”

“…Therefore, the reverse-flow sural flap provides an easy reconstruction option in our sittings. The reverse sural fasciocutaneous flap, based on peroneal perforating arteries, is a quick, adaptable, and non-challenging technique, eliminating the need for microvascular surgery [ 7 ].…”

Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

“…The remaining 28 studies with 167 patients reported the site of the wounds: 95 at posterior ankle/heel, 18 at dorsal/plantar midfoot, and 43 at the ankle region. 12,14,15,[18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37][38]41,[43][44][45][46][47] Diabetes duration was not reported in most studies. Most studies did not report ulcer duration while many emphasized on the chronicity of the included wounds, most resistant to topical management.…”

“…15,20,22,27,37,38,43,46,47 Seventeen studies reported the flap area with a mean size of 50.4 + 28.62 cm 2 . 14,18,19,21,23,26,[29][30][31][32][34][35][36]39,41,45,47 Twenty-four studies reported the mean width of their flap pedicles with a pooled mean width of 3.56 + 1 cm. 12,15,19,[21][22][23][26][27][28][29][30][31][32][33][34][35][37][38][39][42][43][44]46,47 Of 174 flaps reporting detailed surgical technique, only 45 (25.8%) tunneled their pedicle subcutaneously.…”