Abstract
Background
A distally based sural flap is a workhorse flap used to reconstruct the distal lower leg and foot. It developed a bad reputation due to venous congestion, leading to flap failure. Herein, we present a new modification in the form of proximal catheterization and distal ligation of the short saphenous vein to relieve flap congestion.
Methods
Twenty patients underwent reconstruction with distally based sural artery flaps for defects around the ankle, distal leg, and foot from June 2019 to March 2021. Distal ligation with proximal catheterization of the short saphenous vein was performed to reduce the risk of venous congestion.
Results
Early flap congestion was observed in five flaps (25%). The venous congestion was relieved by draining congested blood through the catheter. The total amount of blood removed was around 80–100 mL in the first 2 days postoperatively. The flaps healed uneventfully as two flaps with distal 2-cm necrosis healed with dressing.
Conclusions
Distal ligation of the short saphenous vein may prevent venous overloading from the foot and reduce sural flap venous congestion. Proximal catheterization of the vein to relieve flap congestion is an effective flap safety tool.
Level of evidence
Level V, Risk/Prognostic.
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Acknowledgements
We would like to acknowledge all the staff member of plastic surgery department, Faculty of Medicine, Al-Azhar University, Al-Hussain University Hospital, Cairo, Egypt.
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The procedures performed in this study were in accordance with the ethical standards of the institutional research committee (Al-Azhar Faculty of Medicine ethical committee, Cairo, Egypt, No. 625-2019) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Authors obtained informed consent from the individual participants included in this study. Participants also provided informed consent for publication of their images in Figs. 2, 3, 4, 5, 6a, 6b, 6c, 6d, 7a, and 7b.
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Abd-AlMoktader, M.A., Youssif, S.H., Sholkamy, K. et al. Distal ligation with proximal catheterization of short saphenous vein to decrease venous congestion in the distally based sural artery flap. Eur J Plast Surg 46, 1185–1191 (2023). https://doi.org/10.1007/s00238-022-02029-x
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DOI: https://doi.org/10.1007/s00238-022-02029-x