Surgical review: the versatile reverse flow sural artery flap for lower 1/3 leg and foot defects: clinical series

Abstract

Background

The soft tissue defects of lower third leg, ankle, and foot present a challenging problem because of the paucity of local tissue and poor circulation of skin in that region. Various forms of coverage including muscle flaps, fascial flaps, and free flaps are used for reconstruction. Each have their specific indications and inherent disadvantages. Distally based fasciocutaneous flap supplied by vascular axis around sural nerve is intensively researched and constitutes another important alternative to lower third and foot reconstruction.

Patients and method

In our department, we have treated 166 patients from January 2004 to December 2008 with reverse sural flap. Majority of patients were due to road traffic accident (RTA). Distal pivot point was kept approximately 5 cm from lateral malleolus, thus preserving the distal most perforator, and the flap was turned and insetted into the defect. Donor site was covered with a split thickness graft. Postoperative follow-up period was 15 days to 1 year at regular intervals.

Results

The procedure was uneventful in 142 cases. Infection/discharge occurred in 12 cases. Partial flap necrosis occurred in 10 cases, with resulting need for minor surgery (debridement and split thickness graft). Total flap necrosis occurred in 2 cases.

Conclusion

Distally based sural flap offers reconstruction of foot, ankle, and lower third leg with a reliable blood supply, easy elevation, and long vascular pedicle with large arc of rotation. Also, there is no sacrifice of major arteries. However, main disadvantages are sacrifice of sural nerve and unsightly scarring of upper calf.