Search

Background The reverse sural artery flap (RSAF) is a popular option for patients with distal lower extremity defects who are not ideal candidates for free flap reconstruction. This is the first systematic review and pooled analysis of surgical characteristics, risk factors, and outcomes of the RSAF. Methods A systematic literature review was conducted. All studies reporting on patients undergoing RSAF reconstruction and their outcomes were included. Outcomes were pooled and analyzed using Fisher exact or χ test. Results Forty-three studies (479 patients, 481 flaps) were analyzed. The majority of patients were male (70.3%), and average ± SD age was 46.9 ± 16.7 years. Rates of smoking, diabetes mellitus (DM), and peripheral vascular disease (PVD) were 34.6%, 35.4%, and 12.3%, respectively. Defect etiologies were largely traumatic (60.4%). The most common defect location was the heel (40.8%). Flap modifications were reported in 123 flaps (25.6%). The most common modification was adipofascial extension (20.3%).Overall, the partial and total flap loss rates were 15.4% and 3.1%, respectively. Partial flap loss was significantly increased in smokers (28.9% vs 12.2% in nonsmokers, P = 0.0195). Technical modifications decreased the odds of partial necrosis by almost 3-fold compared with traditional RSAF reconstruction (7.2% vs 17.9%; odds ratio, 2.8 [1.4-5.8]; P = 0.0035). Patient age, DM, and PVD were not significantly associated with flap loss. Conclusions The RSAF remains a safe salvage option for patients with DM or PVD but should be used with caution in smokers. Technical modifications to minimize pedicle compression significantly reduce rates of partial necrosis.

We report a case of young patient with a postoncologic right buccomandibular defect in which the deepithelialized medial sural artery perforator flap was used to obtain a symmetric contour of the defective side. The aim of this study was to compare treatment strategies of facial contour deformities and to give detailed information about medial sural artery flap dissection with a clinical presentation.

Background Open achilles tendon injuries, present a complex problem to the treating surgeon especially if associated with tendon and soft tissue loss. We present eight such patients treated with tendon repair/reconstruction and reverse flow sural artery flap for soft tissue cover. Patients Eight patients (age, 12-64 years) with a spectrum of open tendo-achilles injuries of acute and chronic (infected), including loss of tendon of up to 10 cm, tendon defects with no distal attachment and one with partial loss of the calcaneum were treated between November 2005 and July 2006. Two of them had significant medical comorbid factors. The skin defect measured after debridement ranged from 6 x 5 cm to 15 x 10 cm. The tendon injuries were sutured directly when possible or sutured to bone if avulsed from the calcaneum. They were otherwise reconstructed using the central part of the proximal segment. A reverse sural artery was used to provide soft tissue cover. Results All flaps survived. All patients had a normal gait, were able to stand on tip toes, had active plantar flexion and had returned to their original occupation 4 months after reconstruction. They had full range of movement at the ankle. One diabetic patient had terminal necrosis of the flap that required a split skin graft. He developed a late infection which did not compromise the functional result. Conclusion In the management of complex tendo-achilles injuries with tendon and soft tissue loss, radical debridement, single stage tendon reconstruction, and reverse flow sural artery flap gives good functional outcome. This gives consistent results across a spectrum of open tendo-achilles injury.

Introduction: The reverse sural artery flap eliminates the need for long and technically demanding free tissue transfers, which have become the gold standard for significant tissue defects in the distal third of the leg and ankle. Unfortunately, the originally described reverse sural artery flap technique has a risk of partial or total flap necrosis as high as 25%. We hypothesized that delaying the flap (the delay time ranged from 48 hours to 2 weeks) and using a 4-cm wide pedicle would decrease the amount of partial flap necrosis that commonly occurs with this flap. Patients: Five patients (3 women, 2 men) with open wounds in the distal lower extremity were treated with delayed fasciocutaneous reverse sural artery flaps elevated on a 4-cm wide pedicle. Results: The patients ranged from 22 to 75 years of age and had sustained defects in the ankle region resulting from trauma. All five wounds healed with favorable functional and asthetic results without any evidence of flap necrosis. Conclusions: In patients with known vasculopathy, a surgical delay of 1 week and increasing the pedicle size to 4 cm may increase the likelihood of graft survival and decrease the amount of partial flap necrosis by dilating the arterial network.

Background: Coverage of a soft-tissue defect of the lower third of the leg is a difficult problem. The reverse sural artery flap, first described by Masquelet, is a random type of flap, based on the superficial sural artery. Methods: We treated 10 patients with 11 reverse sural artery flaps. A modification of flap transposition through a subcutaneous tunnel with the aid of a soft-tissue expander was described to prevent venous congestion, especially in longer tunnels, for flap insetting. Results: Eight flaps survived completely. Distal tip and partial skin necrosis was observed in three flaps in two diabetic patients (27.2 percent). No venous congestion was observed after this modification. Conclusion: The reverse sural artery flap is a reliable alternative for small to moderate size defects and can be used with modifications of the original technique.

The reverse sural artery fasciomusculocutaneous flap has become an acceptable technique of lower-limb reconstruction despite the grafted appearance of the donor site in the upper leg. In an attempt to reduce the donor-site morbidity, we describe the use of the adipofasciomuscular reverse sural artery flap in a patient with a heel sinus and underlying calcaneal osteomyelitis.

Open fractures in children have a high level of morbidity and require early treatment. This case describes the successful treatment of a child who sustained an open tibial fracture with soft tissue loss. The fracture was stabilized with a monolateral external fixator devised in our clinic, and the soft tissue loss was covered with a distally based sural artery flap. The flap is simple, can be done quickly, and a surgeon does not need microsurgical or specialty training to perform the operation. This combined use of external fixation and distally based sural artery flap is a straightforward technique in distal tibial open fractures of children with soft tissue loss.