The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients (original) (raw)
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Soft-Tissue Reconstruction of the Foot With Distally Based Neurocutaneous Flaps in Diabetic Patients
Annals of Plastic Surgery, 2002
Background: Soft tissue cover over the lower part of the leg, the ankle and the foot, is a difficult task for plastic surgeon especially with exposure of bones or tendons. Main options are distant tissue transfer, reverse distally based flaps available for covering soft tissue defect in these areas. The aim of the study is to know the effectiveness of hyperbaric oxygen therapy as an adjunct for flap coverage. Methods: Sixteen patients with soft tissue defect of foot and lower third leg region were treated over a period of 7 months. The lateral supramalleolar flap was used in 11 cases and distally based sural flap was used in 5 cases for the reconstruction of skin defects of the ankle and foot that exposed the bone or tendons. Hyperbaric oxygen therapy was used as an adjunct in the management of soft tissue defects which requires a distally based flap cover. Results: Of the 16 patients, 10 were males and 6 were females, with a range 13 to 72 years. The length of the flap varied from 4 cm to 14 cm (mean 6.5 cm) and the width varied from 4 cm to 5 cm (mean 4.1 cm). Superficial necrosis developed in one lateral supramalleolar flap, but this was successfully treated by debridement skin graft. Among the sixteen flaps, thirteen cases survived completely. The soft tissue defect was due to trauma in 13 cases, assault in one case, tumor in one case and osteomyelitis in one case. Out of sixteen cases, seven were islanded fasciocutaneous lateral supramalleolar, two was fasciocutaneous lateral supramalleolar, one was adipofasciallateral supramalleolar, one was propeller type lateral supramalleolar, three were extended reverse sural and two were island reverse sural flap in nature. Two cases had necrosis at the tip of the flap managed conservatively. The donor site morbidity was minimal. Conclusion: The Lateral supramalleolar flap and distally based sural flap with hyperbaric oxygen therapy as an adjunct improves survival of medium sized soft tissue defects in these regions.
Reverse sural artery flap: a reliable alternative for foot and ankle soft tissue reconstruction
European Journal of Orthopaedic Surgery & Traumatology, 2018
Introduction Soft tissue defects of foot and ankle are challenging due to the susceptibility of the area to trauma and the complexity of the region. Several flaps have been described for wound coverage after surgical debridement at this location. The purpose of this study is to present the reverse sural flap for covering soft tissue defects at the ankle and foot. Materials and methods From July 2014 to November 2017, ten patients with soft tissue defect at the ankle and foot were retrospectively reviewed. There were nine men and one woman with a mean age of 40.5 years (range 17-71 years). Seven patients were smokers and five were diabetics. The mean size of the defect was 50.5 cm 2. All operations were performed by the same microsurgical team. At a mean follow-up of 21 months (range, 18 to 24 months), we evaluated wound healing and complications. Results In nine patients, the soft tissue defect was successfully covered. In four patients, venous congestion was noticed, whereas in one patient, there was total necrosis of the flap. In all cases, the donor site was healed uneventfully. Conclusion The reverse sural artery flap is a reliable alternative for wound coverage at the ankle and foot, with low complication and morbidity rate. Nevertheless, it is a demanding microsurgical operation that requires knowledge of the anatomy and surgeons' experience.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2014
Soft tissue defects over the mid- and distal third tibia, heel, dorsum and plantar aspect of the foot and over the medial, lateral and posterior aspect of the ankle are a common scenario in clinical orthopaedic practice. In this article, we describe the utility of the reverse sural fasciocutaneous flap with a cutaneous pedicle in 109 clinical cases with distal lower limb soft tissue defects. A total of 109 patients were operated on for moderate (5-15 cm) and large (more than 15 cm) soft tissue defects at various sites along the lower limb including foot, heel and sole with the reverse sural fasciocutaneous flap. The defects were secondary to trauma (61 cases), diabetic ulcers (12 cases), post-traumatic scar contracture (8 cases), venous ulcer (4 cases), wound dehiscence (10 cases), leprotic non-healing ulcer (1 case), post-infective wound (1 case), radiation-induced ulcer following radiotherapy for synovial cell sarcoma (1 case), post-fibromatosis excision (1 case), post-dermatofibr...
Acta Medica Philippina
Background. The coverage of soft tissue defects of the distal leg, ankle or foot poses several challenges to the reconstructive surgeon. Reconstructive procedures may range from simple skin grafting to complicated free tissue transfers. The reverse sural flap has been one of the most dependable methods for soft tissue coverage of such complex wounds. The purpose of this paper was to compare the clinical results of reverse sural flaps harvested with a fascial versus a fasciocutaneous pedicle. Methods. A retrospective cohort of twenty-six patients who underwent a reverse sural flap procedure for complex wounds of the distal lower extremity was examined from January 1, 2003 to December 31, 2009, with a minimum follow-up of one month. Fifteen patients had a fascial pedicled flap, while eleven patients had fasciocutaneous pedicled flaps with a minimum of one month follow-up. The primary outcome was flap-related complications. Fisher's exact test was used to determine the differences between the two groups and the level of significance was set at p≤0.05. Results. All flaps survived. Flap-related complications were more common in the fascial pedicled flap (6/15) compared with the fasciocutaneous pedicled flap (1/11). The difference was not significant (p=0.09). In terms of cosmetic acceptability, 11 patients (11/15) in the fascial pedicle group and five patients (5/11) in the fasciocutaneous pedicle group expressed that the sural flap was acceptable. Conclusion. Reverse sural flap was a reliable reconstructive procedure for coverage of soft tissue defects of the distal leg, ankle or foot. There was no significant difference in terms of complication rates for those with fascial compared with those with fasciocutaneous flaps. Cosmetic acceptability was higher for the fascial pedicled flap.
Modified Sural Flap to Cover Distal Lower Limb Soft Tissue Defects
Egyptian Journal of Orthopedic Research
The purpose of this study was to evaluate the outcomes of coverage of soft tissue defects of leg and foot by sural flap with preserving a lane of skin over the pedicle (cutaneous pedicle) with open passage between donor and recipient sites. A proscriptive study including thirty-six patients with distal lower limb soft tissue defects was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. All these 36 patients underwent modified sural flap with preserved lane of skin over the pedicle with open passage for the pedicle between donor and recipient sites. Evaluation of viability of the flap, resistance against infection, healing of the flap, donor site healing and weight bearing, postoperative follow up to nine months. Group of patients including thirty-six patients with distal lower limb soft tissue defects underwent modified sural flap, the indication for flap cover was Motor car accident in 26 cases (72.2%) and exposed plate was in 6 cases (16.7%) crushing trauma was in 4 cases (11.1%). Infection were the common complications encountered Six cases (16.7%) three cases (8.35%) complicated by distal ischemia and One case (2.8%) was totally lost with increase in the flap viability with modified sural flap. Modified sural flap by preserving alane of skin over the pedicle and open passage between donor and recipient site increase venous return of the flap and increase flap viability.
Journal of Orthopaedics and Traumatology, 2012
Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. Four patients were retrospectively analyzed. Soft tissue reconstruction was achieved in all cases. In one case hardware removal was necessary for complete healing. The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply.
Modern Plastic Surgery, 2018
Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive procedure. Free tissue transfer remains the standard for the management of these defects. However, there are some disadvantages like; longer operative times, bulky contour, and the need for highly skilled expertise. The reverse superficial sural artery flap (RSSAF) is a distally based fasciocutaneous or adipo-fascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Methods: Twenty RSSAF flaps were harvested for reconstruction of different traumatic soft tissue defects of the lower third of leg, ankle and foot. Follow up for 6 months postoperative. Results: Twenty Patients; twelve males and eight females underwent reconstruction of different soft tissue defects over the foot and ankle using RSSAF. The overall complications occurred in 6 flaps; 4 minor and 2 major complications. The remaining 14 flaps passed an uneventful follow up. Conclusions: The reverse superficial sural artery flap RSSAF can be used as a reliable alternative to free tissue transfer in reconstruction of defects over the lower third of leg, ankle, and foot. Venous congestion is the major threat to the flap but its incidence can be minimized by wide pedicle, less kink of the flap, and keep the venae comitants around the artery.
Introduction and importance: Foot and ankle soft-tissue defects constitute a real challenge to reconstructive surgeons because of restricted local soft tissue availability. We report a 28 years old male with a significant softtissue defect on the left anteromedial ankle and dorsal foot. Case presentation: A 28 years old male with soft-tissue necrosis on the left anteromedial ankle and dorsal foot, as well as second-fourth metatarsal fractures with gangrene of the first-third phalanx, presented to our hospital 14 days after a traffic accident. He underwent debridement and amputation of the gangrenous fingers. In the second operation, a pin fixation of the metatarsal fractures and the reverse sural flap was performed. The donor site was covered with a split-thickness skin graft. The wounds began to improve significantly on the tenth day after the surgery, and his wounds were gone entirely in the third week. The pins were removed eight weeks after the surgery with the fractures healed. Clinical discussion: Skin grafts are easy and quick to cover open wounds but cannot be applied to cover bare tendons or bone. Local flaps of the distal third of the lower extremity have a limited range of motion and arc of rotation. Free flaps are an acceptable but complex reconstructive surgery that requires long operative time, special instruments, and microsurgical training and are expensive. Conclusion: The reverse sural flap was considered feasible in reconstructing patients with soft-tissue defects of the distal leg, ankle, and foot, especially in resource constraint scenarios.