RECONSTRUCTION OF SOFT TISSUE DEFECTS AROUND KNEE AND PROXIMAL LEG USING PROXIMAL BASED SURAL ARTERY FLAP

Authors

  • Sumaira Abdul Sattar Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan
  • Waqas Sami Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan
  • Faisal Akhlaq Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan
  • Saira Bhutto Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan
  • Shiza Mehak Sohail Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan
  • Rabeeaa Farrukh Dr Ruth K.M Pfau Civil Hospital Karachi (Dow University of Health Sciences) Karachi-Pakistan

DOI:

https://doi.org/10.55519/JAMC-03-12960

Keywords:

Soft tissue defects, Knee and proximal leg, proximally based sural artery flap, Reconstruction, Surgical outcomes, Flap survival, Complications

Abstract

Background: Soft tissue defects around the knee and proximal leg represent a challenging clinical scenario for plastic and reconstructive surgeons. These defects can arise from a variety of causes, including traumatic injuries, such as crush injuries and road traffic accidents, thermal injuries like burns, and surgical complications such as infection. Objective of the study was to evaluate the success of proximally based sural artery flap for soft tissue defects around the knee and proximal leg in patients presenting to our tertiary care hospital. Methods: This prospective observational study was conducted at the Department of Plastic & Reconstructive Surgery, Civil Hospital, Karachi, Pakistan. The study included patients with soft tissue defects around the knee and proximal leg, excluding those with specific comorbidities, high BMI, or active smoking. Non-probability convenience sampling was employed. After ethical review committee approval and informed consent, if needed wounds were optimized with thorough debridement then patients underwent proximal-based sural artery flap surgery for soft tissue defects around knee and proximal leg. Flap survival and complications were assessed over three to six weeks. Results: The study included 37 patients, with a median age of 30 years. The most frequent cause of defects was road traffic accidents (73%). Of the patients, 73% were male, and 27% were female. The median duration of soft tissue injury was 5 weeks, and the median duration of surgery was 90 minutes. Flap survival was 97.3%, with 28 flaps surviving without any complications. One patient with a 20-year-old chronic defect experienced partial flap failure. Conclusion: The use of the proximally based sural artery flap represents a promising approach for the successful reconstruction of soft tissue defects around the knee and proximal leg.

References

Ganji Raveendra Reddy MS, Mohan A, Jyothsna B, Reddy DBS, Rao P. Proximal Sural Artery Flap for Knee Defects. J Dent Med Sci 2021;20(4):36–9.

Deng C, Wei Z, Wang B, Jin W, Zhang W, Tang X, et al. The proximally based lateral superficial sural artery flap: a convenient and optimal technique for the reconstruction of soft-tissue defects around the knee. Int J Clin Exp Med 2016;9(8):15167–76.

Opara K, Nwagbara I. Reconstruction of complex soft-tissue defects around the knee using the proximally based sural Island fasciocutaneous flap. Niger J Clin Pract 2018;21(6):726–30.

Martinov M, Argirova M. Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series. Orthop Surg 2022;9:1–8.

Leclère FM, Eggli S, Mathys L, Vögelin E. Anatomic study of the superficial sural artery and its implication in the neurocutaneous vascularized sural nerve free flap. Clin Anat 2013;26(7):903–10.

Khundkar R. Lower extremity flap coverage following trauma. J Clin Orthop Trauma 2019;10(5):839–44.

Suri MP, Friji MT, Ahmad QG, Yadav PS. Utility of proximally based sural artery flap for lower thigh and knee defects. Ann Plast Surg 2010;64(4):462–5.

Contedini F, Negosanti L, Fabbri E, Pinto V, Tavaniello B, Sgarzani R, et al. Cross-Leg as Salvage Procedure after Free Flaps Transfer Failure: A Case Report. Case Rep Orthop 2012;2012:205029.

Arafa AL, Youssef G. Proximally Based Sural Artery Flap. Egyp J Plast Reconstr Surg 2018;42(1):177–81.

Luo Z, Ni J, Lv G, Wei J, Liu L, Peng P, et al. Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients. J Orthop Surg Res 2021;16(1):52.

Pan H, Zheng Q, Yang S. Utility of proximally based sural fasciocutaneous flap for knee and proximal lower leg defects. Wounds 2014;26(5):132–8.

Ilyas Tahirkheli MU, Ellahi I, Dar MF, Sharif A. Distal Based Sural Fascio-Cutaneous Flap: A Practical Limb Saviour for Wounds of War and Peace. J Coll Physicians Surg Pak 2016;26(5):399–402.

Li Z, Li P, Tan Q. Reconstruction of Soft Tissue Defects Around the Knee With Pedicled Perforator Flaps. Ann Plast Surg 2018;81(4):462–7.

Singh K, Punia S, Singh B, Pramod D. Outcome of proximally based sural artery flap for the coverage of defects around knee joint. Nigerian J Plast Surg 2017;13(2):45–9.

Reddy G, Mohan A, Jyothsna B, Reddy D, Rao P. Proximal Sural Artery Flap for Knee Defects. SAS J Surg 2020;6:56–9.

Langer V. Management of Major Limb Injuries. ScientificWorldJournal 2014;2014:640430.

Park KH, Oh CW, Kim JW, Lee HJ, Kim HJ. Reliability of reverse sural artery fasciocutaneous flap in older adult patients: Comparison study between older and younger patients. Injury 2023;54(8):110915.

Thiessen FE, Andrades P, Blondeel PN, Hamdi M, Roche N, Stillaert F, et al. Flap surgery for pressure sores: should the underlying muscle be transferred or not? J Plast Reconstr Aesthet Surg 2011;64(1):84–90.

Deng C, Wei Z, Wang B, Jin WH, Zhang WD, Tang XJ, et al. The proximally based lateral superficial sural artery flap : a convenient and optimal technique for the reconstruction of soft-tissue defects around the knee. Int J Clin Exp Med 2016;9(8):15167–76.

Opara KO, Nwagbara IC. Reconstruction of complex soft-tissue defects around the knee using the proximally based sural Island fasciocutaneous flap. Niger J Clin Pract 2018;21(6):726–30.

Downloads

Published

2024-09-08