Search

Background: A distally based sural flap is a workhorse flap used to reconstruct the distal lower leg and foot. It developed a bad reputation due to venous congestion, leading to flap failure. Herein, we present a new modification in the form of proximal catheterization and distal ligation of the short saphenous vein to relieve flap congestion. Methods: Twenty patients underwent reconstruction with distally based sural artery flaps for defects around the ankle, distal leg, and foot from June 2019 to March 2021. Distal ligation with proximal catheterization of the short saphenous vein was performed to reduce the risk of venous congestion. Results: Early flap congestion was observed in five flaps (25%). The venous congestion was relieved by draining congested blood through the catheter. The total amount of blood removed was around 80–100 mL in the first 2 days postoperatively. The flaps healed uneventfully as two flaps with distal 2-cm necrosis healed with dressing. Conclusions: Distal ligation of the short saphenous vein may prevent venous overloading from the foot and reduce sural flap venous congestion. Proximal catheterization of the vein to relieve flap congestion is an effective flap safety tool. Level of evidence: Level V, Risk/Prognostic. [ABSTRACT FROM AUTHOR]

A series of ten patients is presented to demonstrate the use of the distally based posterior tibial island flap with or without a muscle component for reconstruction of the foot. Six patients had defects due to a road traffic accident, two had defects due to a work accident, one had extensive scar contractures after a deep burn and advanced Buerger’s disease in another. There was complete survival of all the flaps but one. Four flaps were fasciocutaneous and six myofasciocutaneous, including the medial hemisoleus muscle. This flap is very useful in lower extremity reconstruction, particularly in the lower third of the leg and foot due to its long vascular pedicle, availability of skin and muscle and ease of elevation. All the island flaps were based on the anastomosis between posterior tibial and peroneal arteries above the medial malleolus. [ABSTRACT FROM AUTHOR]