Author(s): Sana saeed1, Farid ahmad khan2, Izza khan3, Sundas javeed4, Komal saeed5
Received: 25/07/2021 | Published: 20/08/2021 | Pages: 49-55 |
Sural artery flap has proved to be a reliable option to reconstruct soft tissue defects of lower leg with no significant morbidity at donor site. Various modifications of flap harvesting technique like extended, delayed proximally /distally based, islanded/peninsular, nerve sparing have been described in various studies. This study highlights modifications in a single series and their outcomes in lower limb defects Methods: This is a retrospective observational study including 35 patients of either gender conducted at Plastic Surgery Department, Services Hospital Lahore. Lower extremity defects requiring soft tissue coverage enrolled from March 2020 to March 2021 were included. Demographic data, clinical details about the defect and post-operative complications were noted. Clinical outcomes of the flap on basis of flap size, operative time, wound healing percentage and complication rate were observed. Results: 35 patients (28 males and 7 females) of mean age of 31.62±13.93 years were included in this case series. The most common cause of lower limb defects was trauma. The ankle and dorsum of foot was the most common location that was covered with extended reverse sural artery flap. Mean flap size was 131.48± 29.46cm2. Mean operative time was 79.71±18.78 min. The complication rate was 14%. Complete wound healing was 97%±3. Conclusion: Sural artery flap is a reliable and versatile option for resurfacing soft tissue defects of lower limb. Various modifications can be wisely utilized to increase the efficacy of flap with lesser complications, extended coverage and less operative time especially in an era of COVID-19 infection.
1. Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. PlastReconstr Surg. 2007; 119(6):138e-148e.
2. 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. PlastReconstr Surg. 1992;89(6):1115-21.
3. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for prediled perforator flaps. PlastReconstr Surg. 2008; 1(122):161-170
4. Dandona R, Kumar GA, Ameer MA, Ahmed GM, Dandona L. Incidence and burden of road traffic injuries in urban India. InjPrev 2008;14:354–9.
5. Amin Yousaf M, Al-abidinM,Khalid K. Extended islanded reverse sural artery flap for staged reconstruction of foot defects proximal to toes. Journal of the College of Physician and Surgeons Pakistan.2018;28:126-128.
6. PatilB,Wahegaonkar C. Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects. International Journal of Research in Medical Sciences.2019; 7(3):866.
7. Ayyappan T, Chadha A. Super sural neurofasciocutaneous flaps in acute traumatic heel reconstructions. PlastReconstrSurg 2002;109:2307–13.
8. Hyakusoku H, Tonegawa H, Fumiiri M. Heel coverage with a T-shaped distally based sural island fasciocutaneous flap. PlastReconstr Surg. 1994;93:872–6.
9. Mak KH. Distally based sural neurocutaneous flaps for ankle and heel ulcers. Hong Kong Med J 2001; 7(3):291–5.
10. Anoop C Dhamangaonkar, Hemant S Patankar. Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: experience of 109 clinical cases. J Orthop Traumatol. 2014 Sep; 15(3):225-9.
11. Kneser U, Bach AD, Polykandriotis E, Kopp J, Horch RE. Delayed reverse sural flap for staged reconstruction of the foot and lower leg. PlastReconstr Surg. 2005; 116(7):1910-7.
12. Schmidt K, Jakubietz M, Meffert R. The reverse sural artery flap- How do modifications boost its reliability? A systematic analysis of the literature. JPRAS Open. 2020 Aug 1;26:1-7.
13. Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Aiso S, Fujino T. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical
study and a concept of the venoadipofascial and/ or neuroadipofascialpedicled fasciocutaneous flap. PlastReconstr Surg. 1998;102(3):779-91.
14. 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. PlastReconstr Surg. 1999; 103(1):104-20.
15. Karacalar A, Idil O, DemirA, Güneren E, Simşek T, Ozcan M. Delay in neurovenous flaps: experimental and clinical experience. Ann Plast Surg. 2004; 53(5): 481-7.
16. Al-Qattan MM. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle “cuff” around the sural pedicle. Ann Plast Surg. 2001;47(3):269-74.
17. Sheraz M, Nazir U, HussianH.Non- islanded distally based sural artery flap: A reliable solution for an unreliable flap.Journal of the College of Physicians and
Surgeon.2016;26(4): 310-314. 18. Aydin OE et al. Nerve sparing-distally based sural flap. Microsurgery. 2011; 4(31):276-280.
19. Almeida MF, da Costa PR, Okawa RY. Reverse-flow island sural flap. PlastReconstrSurg 2002; 109(02): 583–591.
20. Baumeister SP, Spierer R, ErdmannD, Sweis R, Levin LS, GermannGK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. PlastReconstrSurg 2003;112(01):129–140
21. Kristoffer B Sugg, Timothy A Schaub, Matthew J Concannon. The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction. PlastReconstrSurg Glob Open. 2015 Sep 22;3.
22. Manav P Suri , M T Friji, Quazi G Ahmad, Prabha S Yadav. Utility of proximally based sural artery flap for lower thigh and knee defects. Annals of Plastic Surgery 2010 Apr;64(4):462-5.
23. Severo AL, Scorsatto C, Valente EB, Lech OL. Retalhos para reconstrução de perdasmusculocutâneasemmem-brosinferiores: análise de 18 casos. Rev Bras Ortop 2004; 39(10):578–589
24. Mehmood M , Shahid S, Ubaid M. Free flap reconstruction after lower limb trauma — outcome analysis using National Surgical Quality Improvement Programme
(NSQIP) parameters. Journal of The Pakistan Medical Association.2020;70.
25. J M Serlettietal. Factors affecting outcome in freetissue transfer in the elderly. PlastReconstr Surg. 2000.
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