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Reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap for reconstruction of lower leg and foot

European Journal of Orthopaedic Surgery & Traumatology volume 24, pages 67–72 (2014)Cite this article

Abstract

Introduction

Paucity of soft tissue available locally for reconstruction of defects in leg and foot presents a challenge for reconstructive surgeon. The use of reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap in reconstruction of lower leg and foot presents a viable alternative to free flap and cross-leg flap reconstruction. The vascular axis of the flap is formed by the vessels accompanying the saphenous nerve and the greater saphenous vein. We present here our experience with reverse saphenous neurocutaneous flap which provides a stable cover without the need to sacrifice any important vessel of leg.

Patients and methods

The study is conducted from March 2003 through Dec 2009 and included a total of 96 patients with defects in lower two-thirds of leg and foot. There are 74 males and 22 females. Distal pivot point was kept approximately 5–6 cm from tip of medial malleolus, thus preserving the distal most perforator, and the flap is turned and inserted into the defect. Donor site is covered with a split thickness skin graft. Postoperative follow-up period was 6 weeks to 6 months.

Result

The procedure is uneventful in 77 cases. Infection is observed in 14 cases. Partial flap necrosis occurs in 2 cases. Total flap necrosis is noted in 3 cases.

Conclusion

Reverse pedicle saphenous flap can be used to reconstruct defects of lower one-third leg and foot with a reliable blood supply with a large arc of rotation while having minimal donor site morbidity.

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Affiliations

  1. A-27, Alok Park, Modinagar, 201204, Ghaziabad, UP, India

    Sandeep Kansal, Pradeep Goil, Vijay Agarwal, Swarnima Agarwal, Shashank Mishra, Deepak Agarwal & Pranay Singh

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  1. Sandeep Kansal
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  2. Pradeep Goil
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  3. Vijay Agarwal
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  4. Swarnima Agarwal
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  5. Shashank Mishra
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  6. Deepak Agarwal
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  7. Pranay Singh
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Correspondence to Sandeep Kansal.

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Kansal, S., Goil, P., Agarwal, V. et al. Reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap for reconstruction of lower leg and foot. Eur J Orthop Surg Traumatol 24, 67–72 (2014). https://doi.org/10.1007/s00590-012-1150-5

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  • DOI: https://doi.org/10.1007/s00590-012-1150-5

Keywords

  • Lower leg
  • Foot
  • Reverse saphenous flap
  • Great saphenous vein
  • Saphenous nerve