Sural Neuro-Cutaneous Flap in the Management of Foot and Ankle Soft Tissue Defects in a Diabetic Population

Assi, Chahine; Fawaz, Wissam; Samaha, Camille

doi:10.12816/0031526

Cited by 4 publications

(8 citation statements)

References 17 publications

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“…Malokov et al 18 demonstrated a theoretical anatomical possibility of using the sural flap in 23 out of 24 amputation specimens with severe vascular disease. In clinical settings, Yildirim et al 19 and Assi et al 20 reported 1 total flap necrosis in their series of diabetic patients; 1 out of 9 Flowchart of the study's methodology. RSFCF, reverse sural fascio-cutaneous flap.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

Assi

Samaha

Moussa

et al. 2018

Foot & Ankle Specialist

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Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compared the reliability of the RSFCF in treating such defects among both populations. Methods. This is a retrospective series with a prospective data collection of 24 patients (11 with type 2 diabetes and 13 in trauma settings) treated with an ipsilateral RSFCF for soft tissue defects of the distal leg and the rear foot. Healing events and complications were recorded and compared for both groups. The mean follow-up was 32 months. Results. Diabetic group versus trauma group showed the following results; mean flap healing time of 24 versus 22 days, donor site healing time of 14 versus 16 days, 1 total flap necrosis in both groups, 3 versus 2 cases of skin edge necrosis, 2 cases of temporary venous congestion in both groups, and 8 versus 10 cases of transient hypoesthesia of the lateral border of the foot. No infection was encountered in both groups and no recurrence of infection in the primary infected diabetic patients. Conclusions. We found the RSFCF to be useful, reproducible, and reliable in treating soft tissue defects with a very low frequency of serious complications. Diabetic patients were found to have similar outcomes when compared with trauma patients. Therefore, diabetes might not be a major factor of flap failure. Levels of Evidence: Level III: Therapeutic

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

Assi

Samaha

Moussa

et al. 2018

Foot & Ankle Specialist

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“…Shoe fitting in twelve patients was described as normal while the remaining two patients described it as acceptable. Thus, this study concluded the sural flap to be a reliable option for treatment of foot and ankle soft tissue defects in the diabetic population due to a low frequency of serious complications (one case of total flap necrosis; 1/14) and patient satisfaction with shoe fitting, rendering it an ideal flap to treat skin losses and infected-noninfected ulcers with or without bone infection [2].…”

Section: Fasciocutaneous Sural Artery Perforator Pedicle Flapmentioning

confidence: 89%

“…Management of soft tissue defects of the lower extremity is very complex and requires advanced microsurgical knowledge to be able to adequately manage these patients. Flap transfer for reconstruction of soft tissue defects of the lower limb becomes even more challenging when comorbidities are present such as in patients with diabetes who exhibit vascular insufficiency and also depending on the location of the defect as in defects of weight-bearing regions [2,3,9]. Despite our advances in recent years regarding surgical technique and overall knowledge of microsurgical reconstruction, the ideal flap for complex soft tissue defects of the lower extremity still remains quite controversial and unidentified.…”

Section: Discussionmentioning

confidence: 99%

“…The sural flap was reviewed in four separate studies as a method of lower limb reconstruction for management of foot and ankle soft tissue defects in the diabetic population, for treatment of wounds with underlying osteomyelitis, for complex lower extremity and foot reconstruction, and in comparison to the medial plantar flap in foot and ankle reconstruction [2,15,18,14].…”

Section: Fasciocutaneous Sural Artery Perforator Pedicle Flapmentioning

confidence: 99%

“…The reliability of the sural neurocutaneous flap was reviewed in 14 patients for management of foot and ankle soft tissue defects in the diabetic population [2]. All patients had type II diabetes and underwent reconstruction using an ipsilateral sural flap to treat defects of the rear foot (n = 11), lateral malleolar region (n = 1), and medial malleolar region (n = 2).…”

Section: Fasciocutaneous Sural Artery Perforator Pedicle Flapmentioning

confidence: 99%

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A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction

Rodriguez-Collazo

Khan

DiPierro

et al. 2018

International Journal of Orthoplastic Surgery

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The evolution of microsurgery and orthoplastics has expanded our ability as surgeons to manage complex lower extremity soft tissue defects. This evolution relies on the understanding of reconstructive surgical principles for problem solving and analyzing outcomes. The purpose of this review is to determine flap selection with a focus on reliability based on the outcomes of lower extremity free tissue transfer versus vascularized perforator pedicle flap transfer in lower limb reconstruction. A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the databases PubMed/MEDLINE. Data were compiled by reviewing the number of patients, age, comorbidities, complications, size and location of defect. Outcomes were analyzed by indicated soft tissue defect size, location and cause, as well as subsequent flap size, type, survival, durability and their functional results. Overall, 72 topic related studies from 2014-2017 were reviewed. Sixteen of the 72 met the final inclusion criteria. Patient study sizes from the included articles ranged from 7-428 cases. The current qualitative systematic review of flap transfer in the lower extremity has contributed a summary of reported outcomes in literature thus far. After analyzing existing evidence, our study found no significant differences between reconstructive options with a paucity of evidence to clearly recommend the ideal flap transfer for microsurgical reconstruction of lower extremity soft tissue defects.

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

et al. 2021

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Background: The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ankle ulcers. Methods: A systematic review was undertaken from MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Only diabetic foot and ankle ulcers were accepted for inclusion and all study designs were included. Proximally based flaps, nondiabetic ulcers, and assisted negative pressure therapy were excluded. Suitability for inclusion was assessed by 2 reviewers. The random-effect estimate was reported for the set outcomes whenever high heterogeneity was present. Metaregression analysis was performed to identify independent risk factors for failure. Results: The search identified 33 relevant studies comprising 187 patients and flap interventions; all but 1 were case-series. The weighted outcomes were as follows: (1) the flap healing rate was 93.3% while 6.6% resulted in total necrosis, (2) the rate of partial flap necrosis was 12%, (3) venous congestion was reported in 6.6% of cases, (4) the infection rate was 8.3%, and (5) the donor site morbidity was 4.6%. No association was found between pedicle width or presence of a subcutaneous pedicle tunnel and the primary outcome of total loss. Conclusions: This review demonstrated excellent results of the flap when covering complicated or large diabetic foot and ankle ulcers. When compared to those published in the literature, our results found RSFCF to be relatively less successful in diabetic wounds than in trauma patients but more successful than in those having associated osteomyelitis and those who were treated with random local flaps.

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Sural Neuro-Cutaneous Flap in the Management of Foot and Ankle Soft Tissue Defects in a Diabetic Population

Cited by 4 publications

References 17 publications

A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction

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

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