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Lambeau neurocutané sural à pédicule distal dans la couverture des pertes de substance des segments distaux du membre inférieur. À propos de 25 cas

Distally-based sural island flap for the reconstruction of distal segments of the lower limb. Report of 25 cases

  • Article Original / Original Article
  • Published:
Médecine et Chirurgie du Pied

Résumé

Introduction

Le lambeau neurocutané sural à pédicule distal (Masquelet et al., 1992) est une technique qui est venue enrichir l’arsenal thérapeutique de la réparation des pertes de substances de l’extrémité distale du membre inférieur.

Patients et méthode

Vingt-cinq patients d’une moyenne d’âge de 46,36 ans souffrant de pertes de substance d’étiologies variées dominées par les pertes de substance d’origine traumatique (52 %) ont été traités par le lambeau neurocutané sural à pédicule distal.

Résultats

La moitié de nos malades avaient un terrain vasculaire, diabétique ou tabagique. La couverture intéressait dans sept cas le tiers inférieur de la jambe, la région du talon dans sept cas, le cou du pied dans cinq cas, la région malléolaire dans cinq cas et un lambeau pour un moignon d’amputation de l’avant-pied. Un recul moyen de 22 mois avec des extrêmes allant de six mois à cinq ans a permis de faire un point sur le taux de complications retrouvé et le résultat fonctionnel et esthétique de la reconstruction ainsi que du site donneur.

Discussion

Les auteurs veulent, à travers la présentation de leurs expériences, mettre le point sur la facilité de levée du lambeau neurocutané sural à pédicule distal, sa grande fiabilité même sur terrains particuliers, ainsi que l’importance de l’apport tissulaire qu’il offre dans la réparation des pertes de substance étendues du tiers inférieur de la jambe, de la cheville et de la région du talon.

Abstract

Introduction

Since it was described for the first time by Masquelet and colleagues in 1992, the distally-based sural neurocutaneous flap has become a technique that has enriched the armamentarium of repairing soft tissue defects in the distal third of the leg which continues to be a difficult area.

Patients and methods

Twenty-five patients with an average age of 46.36 years, with defects due to varied etiologies dominated by trauma (52%), were treated by the distallybased sural neurocutaneous flap.

Results

Half of our patients had a vascular field, diabetes or smoking. Cover interested in 7 cases the lower third of the leg, the heel area in 7 cases, the instep in 5 cases, the malleolar region in 5 cases and and in one case a flap for amputation stump of the forefoot. A mean of 22 months follow up, with a range from 6 months to 5 years, has allowed to make a point on the rate of complications found and the functional and aesthetic outcomes of the reconstruction as well as the donor site.

Discussion

The authors went through the presentation of their experience, and put the focus on the ease of harvesting the flap, on its high reliability even on people with vascular issues, and the importance of the contribution that tissue provides in repairing extensive defects in the lower third of the leg, the ankle and the heel region.

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Authors and Affiliations

  1. Service de chirurgie plastique, réparatrice et des brûlés, centre hospitalier universitaire Mohammed-VI, Marrakech, Maroc

    H. Droussi, M. -D. Elamrani, K. Elatiqi, M. Dlimi, S. Boukind, Y. Benchamkha & S. Ettalbi

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  1. H. Droussi
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  2. M. -D. Elamrani
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  3. K. Elatiqi
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Correspondence to H. Droussi.

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Droussi, H., Elamrani, M.D., Elatiqi, K. et al. Lambeau neurocutané sural à pédicule distal dans la couverture des pertes de substance des segments distaux du membre inférieur. À propos de 25 cas. Med Chir Pied 30, 75–85 (2014). https://doi.org/10.1007/s10243-014-0393-8

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