Author(s): Sobia Manzoor,1 Nauman Ahmed Gill,2 Ehsan Ahmed Khan3
Received: 03/08/2021 | Published: 04/09/2021 | Pages: 56-60 |
Standard reverse sural artery flap is a valuable option for reconstruction of soft tissue defects of lower third of leg, hind foot and dorsum of foot, but it is prone to develop venous congestion. We have introduced a novel technique of extended pedicle reverse sural artery flap which has shown better flap survival and outcome.
Methodology: This was a retrospective review of data of patients who underwent standard or extended pedicle reverse sural artery flap for post traumatic wounds of lower leg, ankle, heel and mid foot dorsum, over a period of 6 years (September 2015 to September 2021). Data was retrieved from hospital admission and operation records and case files of the patients for analysis. Outcome variables like flap survival and pattern of necrosis were recorded. Results: Of the 56 patients who underwent reverse sural artery flap coverage for distal lower extremity, Standard reverse sural artery flap was done in 30(53.6%) and Extended pedicle flap done in 26(46.4%) patients. The mean± SD age of the patients was 15.96±11.3 years. Males accounted for 66.1% (n=37) of patients. Non weight bearing heel was the most common site (n=25, 44.7%), whereas wheel spoke injury was the most common cause(n=33, 58.9%). Mean size of wound was 8.2×6.5 cm for which dimensions of flap elevated were 9×7 cm. Rate of complications was significantly less in extended pedicle reverse sural artery flap (p value 0.037). Flap survival was 25(96.2%) in Extended pedicle reverse sural artery flap group (p value 0.008) with Excellent outcome (p value 0.006). Conclusion: Extended pedicle reverse sural artery flap is reliable option for coverage of defects around ankle and heel with better flap survival and excellent outcome.
1. Sugg KB, Schaub TA, Concannon MJ, et al.“The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction”. Plast ReconstrSurg Global Open Glob Open 2015 Sep 22; 3(9):e519.
2. Crowe CS, Cho DY, Kneib CJ, Morrison SD, Friedrich JB, Keys KA. Strategies for reconstruction of the plantar surface of the foot: a systematic review of the literature. Plast Reconstr Surg. 2019;143(4):1223-1244
3. Yousaf MA, Abidin ZU, Khalid K, et al. Extended Islanded Reverse Sural Artery Flap for Staged Reconstruction of Foot Defects Proximal to Toes. J Coll phy surg 2018; 28(2) : 126-128.
4. Lee HI, Ha SH, Yu SO, et al. Reverse sural artery island flap with skin extension along the pedicle. J Foot Ankle Surg. May-Jun 2016;55(3):470-5.
5. Han Y, Han YD, Song BQ, Guo LL, Tao R, Chai M. Free medial plantar flap versus free dorsal myocutaneous flap for the reconstruction of traumatic foot sole defects. Ann Plast Surg. 2020;84:S178–85.
6. Olawoye OA, Ademola SA, Iyun K, Michael A, Oluwatosin O. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Int Wound J. 2014;11:2104.
7. Wei JW, Ni JD, Dong ZG, Liu LH, Luo ZB, Zheng L. Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg, ankle, and foot: comparison between pediatric and adult patients. J ReconstrMicrosurg. 2014;30:249–54.
8. C de Blacam, S Colakoglu, AA Ogunleye. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis. J PlastReconstrAesthet Surg. 2014: 67; 607-616.
9. S Persaud, A Chesser, R Pereira, A Ross. Sural Flap Use for the Treatment of Wounds With Underlying Osteomyelitis: Graft Size a Predictor in Outcome, a Systematic Review. Foot Ankle Spec 2017: 10 (6); 5.
10. C Assi, C Samaha, M Chamoun Moussa, T Hayek, K Yammine. A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients. Foot Ankle Spec 2019: 12 (5); 432- 438.
11. Anlatici R. Reverse Sural Flap for Repair of Foot and Ankle Defects: Our Cases, Modifications, and a Literature Review. Plastic surgery case series 2020: 6;1-7.
12. El-Diwany M, Karunanayake M, Al-Mutari S, et al. Super-drained distally based neurofasciocutaneous sural flap: a case series and review of literature. Eplasty. 2015 May 12;15:e16.
13. Parcells AL, Keith J., Granick M. (2017) Reverse Sural Artery Flap. In: Anh Tran T., Panthaki Z., Hoballah J., Thaller S. (eds) Operative Dictations in Plastic and Reconstructive Surgery. Springer, Cham. https:// link. springer.com/chapter/10.1007/978-3-319-40631- 2_132
14. Wei JW, Dong ZG, Ni JD, et al. Influence of flap factors on partial necrosis of reverse sural artery flap: a study of 179 consecutive flaps. J Trauma Acute Care Surg. 2012 Mar;72(3):744-50.
15. Luo, Z, Ni, J, Lv, G, et al. Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients. J OrthopSurg Res 2021; 16: 52.
All published material becomes the sole property of the Pakistan Journal of Plastic Surgery, copyrighted by the Pakistan Association of Plastic Surgeons (PAPS). By submitting an article or brief communication, all authors agree to these conditions.
During the submission process, all authors have required to complete a copyright transfer agreement, “Author Consent form” By completing the copyright transfer agreement, you are transferring copyright of figures, tables, videos, and the content of the manuscript to the Pakistan Association of Plastic Surgeons (PAPS).
If you do not wish to or cannot transfer copyright of some or all of your content, please contact the editorial office at pjpspakistan@gmail.com