ROLE OF REVERSE SURAL ARTERY FLAP FOR SOFT TISSUE DEFECTS OF LOWER LIMB: EXPERIENCE WITH 66 CASES
Abstract
Background: Reverse sural artery flap has proved to be a good option to reconstruct soft tissue defects of lower limb and foot region. Different studies, however, speak of its use in different areas depending upon the individual experiences. Various modifications of the flap technique have been described in various studies. This study highlights many of the modifications in a single series and the fact that extending its arc of rotation, flap has capacity to deal with defects of middle and lower thirds of leg, heel, ankle, sole, dorsum and forefoot. Methods: In this case series, flap was utilized in 66 cases. Extension of skin paddle up to knee joint crease level increased the arc of rotation and as a result series witnessed this flap covering defects at the forefoot level. A good number of modifications suggested in literature were utilized to get optimal results. Results: Lower leg defects were covered in 26 cases. Heel was the site of defect in 18 patients. Dorsum foot needed soft tissue cover in other 15cases. Flap was successful in 62 cases and it failed in 4 cases. Conclusions: Flap due to its long arc of rotation has the capacity to deal the defects of middle and lower thirds of leg, heel, ankle, sole, dorsum and forefoot. Various modifications can be wisely utilized to increase the efficacy of the flap.Keywords: Flaps, Lower limb Reconstruction, Perforator flaps, Reverse Sural Artery FlapReferences
Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89:1115–21.
Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Fukui Y, Miyasaka T, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 1999;103:104–20.
Le Fourn B, Caye N, Pannier M. Distally based sural fasciomuscular flap: anatomic study and application for filling leg or foot defects. Plast Reconstr Surg 2001;107:67-72.
Imanishi N, Nakajima H, Fukuzumi S, Aiso S. Venous drainage of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap: A radiographic perfusion study. Plast Reconstr Surg 1999;103:494–98.
Coert JH, Dellon AL. Clinical implications of the surgical anatomy of the sural nerve. Plast Reconstr Surg 1994; 94:850–55.
Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg1994;93:1012–20
Jeng SF, Wei FC. Distally based sural island flap for foot and ankle reconstruction. Plast Reconstr Surg 1197;99:744–50
Huisinga RL, Houpt P, Dijkstra R, Storm van Leeuwen JB. The distally based sural artery flap. Ann Plast Surg 1998;41:58–65.
Coskunfirat OK, Velidedeoglu HV, Sahin U, Demir, Z. Reverse neurofasciocutaneous flaps for soft-tissue coverage of the lower leg. Ann Plast Surg 1999;43:14–20.
Jeng SF, Wei FC, Kuo YR. Salvage of the distal foot using the distally based sural Island flap. Ann Plast Surg 1999;43:499–505
Tosun Z, Özkan, A, Karaçor Z, Savaci N. Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot. Ann Plast Surg. 2005;55:169–73
Karacalar A, Idil O, Demir A, Guneren E, Simsek T, Ozcan M. Delay in neurovenous flaps: experimental and clinical experience. Ann Plast Surg 2004;53:481–7.
Lo JC, Chen HC, Chen HH, Santamaria E. Modified reverse sural artery flap. Changgeng Yi Xue Za Zhi. 1997;20:293–8.
Hassanpour SE , Mohammadkhah NM, Arasteh E. Is It Safe to Extract the Reverse Sural artery Flap from the Proximal Third of the Leg? Arch Iran Med 2008;11:179–85.
Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg 2002;110:1673–9.
Foran MP, Schreiber J, Christy MR, Goldberg NH, Silverman RP. The modified reverse sural artery flap lower extremity reconstruction. J Trauma 2008;64:139–43.
Ayyappan T, Chadha A. Super sural neurofasciocutaneous flaps in acute traumatic heel reconstructions. Plast Reconstr Surg 2002;109:2307–13.
Tan O, Atik B, Bekerecioglu M. Supercharged reverse-flow sural flap: a new modification increasing the reliability of the flap. Microsurgery 2005;25:36–43.
Gozu A, Ozyigit T, Ozsoy Z. Use of distally pedicled sural fasciocutaneous cross-leg flap in severe foot and ankle trauma: a safe alternative to microsurgery in very young children. Ann Plast Surg 2005;55:374–7.
Price MF, Capizzi PJ, Watterson PA, Lettieri S. Reverse sural artery flap: caveats for success. Ann Plast Surg 2002;48:496–504.
Yilmaz M, Karatas O, Barutcu A. The distally based superficial sural artery island flap: clinical experiences and modifications. Plast Reconstr Surg 1998;102:2358–67.
Ahmed SK, Fung BK, Ip WY, Fok M, Chow SP. The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature. J Orthop Surg Res 2008,3:15
Al Qattan MM. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg:inclusion of gastrocnemius muscle 'cuff' around the sural pedicle. Ann Plast Surg 2001;47:269–74.
Al-Qattan MM. Lower-limb reconstruction utilizing the reverse sural artery flap-gastrocnemius muscle cuff technique. Ann Plast Surg 2005;55:174–8.
Gideroglu K, Yildrim S, Akan M, Akoz T. Immediate use of medicinal leeches to salvage venous congested reverse pedicled neurocutaneous flaps. Scand J Plast Reconstr Surg Hand Surg 2003;37:277–82.
Dandona R, Kumar GA, Ameer MA, Ahmed GM, Dandona L. Incidence and burden of road traffic injuries in urban India. Inj Prev 2008;14:354–9.
Hyakusoku H, Tonegawa H, Fumiiri M. Heel coverage with a T-shaped distally based sural island fasciocutaneous flap. Plast Reconstr Surg. 1994;93:872–6.
Mak KH. Distally based sural neurocutaneous flaps for ankle and heel ulcers. Hong Kong Med J 2001;7(3):291–5.
Dolph JL. The superficial sural artery flap in distal lower third extremity reconstruction. Ann Plast Surg 1998;40:520–2.
Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg. 2006;59:8.839–45.
Mahmood F, Mehrose MY, Tasneem S, Mahmood N, Raza A. Distally based superficial sural artery flap for foot and ankle reconstruction in children. J Ayub Med Coll Abbottabad 2011;23(4):40–2.
Costa-Ferreira A, Reis J, Pinho C, Martins A, Amarante J. The distally based island superficial sural artery flap: clinical experience with 36 flaps. Ann Plast Surg 2001; 46:308–13.
Rajacic N, Darweesh M, Jayakrishnan K, Gang RK, Jojic S. The distally based superficial sural flap for reconstruction of the lower leg and foot. Br J Plast Surg 1996;49:383–9.
Price MF, Capizzi PJ, Watterson PA, Lettieri S. Reverse sural artery flap: caveats for success. Ann Plast Surg 2002;48:496–504.
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