The Distally Based Lesser Saphenous Venofasciocutaneous Flap for Ankle and Heel Reconstruction

Abstract

Finding an appropriate soft-tissue grafting material to close a wound located over the ankle and heel can be a difficult task. The distally based lesser saphenous venofasciocutaneous flap mobilized from the posterior aspect of the upper leg, used as an island pedicle skin flap, can be useful for this purpose. The vascular supply to the flap is derived from the retrograde perfusion of the accompanying arteries of the lesser saphenous vein. These arteries descend along both sides of the lesser saphenous vein to the distal third of the leg, either terminating or anastomosing with the septocutaneous perforators of the peroneal artery. Between February of 1999 and March of 2001, four variants of this flap were applied in 21 individuals, including 11 fasciocutaneous, five fascial, three sensory, and two fasciomyocutaneous flaps. Skin defects among all patients were combined with bone, joint, and/or tendon exposure. The authors found that the flap was reliable and technically simple to design and execute. This one-stage procedure not only preserves the major arteries and the sural nerve of the injured leg, but it also has proved valuable for covering a weight-bearing heel and filling a deep defect, because it potentially provides protective sensation and a well-vascularized muscle fragment. When conventional local flaps are inadequate, this flap should be considered for its reliability and low associated morbidity.

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

“…Various modifications of the sural and peroneusbrevis flaps have been described to optimize the outcome and minimize complications [63][64][65][66][67] . The distally based peroneus brevis flap has been described as an efficient tool for the reconstruction of the distal lower leg, ankle, Achilles tendon and proximal foot region [4,65,[68][69][70][71][72][73] . This flap can be indicated to cover exposed vessels, bones, tendons, and internal fixation hardware.…”

Distally based sural fasciomyocutaneous flap: Anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel

“…28 There were limited reports regarding the reinnervation of distally based flaps that transferred to plantar heel and foot by end-to-end or end-to-side neurorhapphy, and the outcome of protective flap sensation without ulceration was achieved. 29,30 In a large distally based sural flap, the proximal part is innervated by the posterior thigh cutaneous nerve and beyond the original distribution of the sural nerve. However, this part of flap may be reinnervated through the peripheral neural ingrowth from the recipient wound, or from the sprouting of the repaired sural nerve.…”

Experience With Reverse Sural Flap to Cover Defects of the Lower Leg and Foot

“…These perforating arteries are most likely to be located in a region four to seven centimeters proximal to the lateral malleolus the ideal pivot point for a pedicle flap1. (1) One of the longest perforators is usually located in the four to five centimeter region above the lateral malleolus which allows this location to be considered a good site for a pivot point (2)(3)(4).…”