A Modified Technique for Transposition of the Reverse Sural Artery Flap

Buluç, Levent; Tosun, Bilgehan; Şen, Cenk Ahmet; Şarlak, Ahmet Yılmaz

doi:10.1097/01.prs.0000219130.32053.29

Cited by 32 publications

(23 citation statements)

References 23 publications

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“…21,22 Patients in the adipofascial group also had a significantly higher occurrence of comorbidities. As the complication rate is known to increase in these patients, the higher complication rate in adipofascial flaps may be attributable not to the flap design itself but to patient population.…”

Section: Discussionmentioning

confidence: 93%

The Distally Based Adipofascial Sural Artery Flap

Schmidt

Jakubietz

Djalek

et al. 2012

Plastic &Amp; Reconstructive Surgery

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Section: Discussionmentioning

confidence: 93%

The Distally Based Adipofascial Sural Artery Flap

Schmidt

Jakubietz

Djalek

et al. 2012

Plastic &Amp; Reconstructive Surgery

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“…25 A modification of flap transposition through an opened pedicle tunnel with the aid of a soft tissue expander is the other modification for preventing postoperative venous congestion of the neurocutaneous flap. 28 Noack et al 13 took various measures to prevent complication of distally based neurovascular sural flaps in a single-stage procedure. A mandatory preoperative angiography, conventional or magnetic resonance, to determine the patency of the peroneal artery and harvesting an enlarged skin paddle with a tail of skin over the pedicle at the pivot point intraoperatively to take pressure off the pedicle and facilitate primary closure and a postoperative fixation device to increase patients compliance were used in their series with favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Using the Pedicle Flap for Taking Pressure off the Pedicle in Distally Based Skin Flaps

Zhao

Wang

Jiang

2013

J reconstr Microsurg

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This report describes our experience using the pedicle flap for taking pressure off the pedicle in distally based skin flaps. Between July 2007 and March 2010, distally based skin flaps were used to treat 34 patients with soft tissue defects in the lower leg, ankle, and foot. A pedicle flap was used to take pressure off the pedicle in all of these flaps. There were 21 men and 13 women with a mean age at surgery of 47 years (range, 21 to 67 years). The sizes of the soft tissue defects varied from 5.0 cm × 2.0 cm to 17.0 cm × 10.0 cm. The pedicle flap sizes varied from 1.0 cm × 1.0 cm to 5.0 cm × 3.5 cm. All flaps survived completely except three, which suffered a marginal partial flap necrosis due to venous congestion. These flaps healed by secondary intention after changing the dressing. Using the pedicle flap takes pressure off the pedicle and facilitates primary closure after transposition of the distally based skin flaps, which is a simple and effective method to prevent complications of these flaps.

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“…Many creative methods of improving outflow in reverse‐flow flaps are described in the literature, including expansion of a subcutaneous tunnel, flap delay, and insertion of a venous catheter to intermittently relieve venous engorgement . Venous supercharging physiologically addresses the arteriovenous imbalance inherent to reverse‐flow flaps.…”

Section: Discussionmentioning

confidence: 99%

“…The dbALT has not gained widespread acceptance. Just as the reverse soleus, reverse sural, and reverse upper extremity flaps are condemned for their tendency toward venous congestion and soft tissue loss, dbALT flap edema and compromise has been reported . Because arteries function bidirectionally and veins rely on small interconnections to bypass functional valves, outflow in reverse‐flow flaps is inherently compromised.…”

mentioning

confidence: 99%

The distally based, venous supercharged anterolateral thigh flap

et al. 2015

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The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. Restoration of antegrade venous drainage via great saphenous vein supercharge to the proximal flap vein is proposed. The purpose of this study was to evaluate and compare outcomes of 18 large, distally-based anterolateral thigh flaps with and without venous augmentation on the basis of flap size, venous congestion, and clinical course. The average age of 12 men and 6 women was 35.9-year old (range, 16-50 years old). Wounds resulting from trauma, burn sequela, sarcoma, and infection were localized to the knee, proximal leg, knee stump and popliteal fossa. The mean defect was 17.6 × 9.4 cm(2) (range, 6 × 7 cm(2) to 22 × 20 cm(2) ). The mean flap size was 21.4 × 8.8 cm(2) (range, 12 × 6 to 27 × 12 cm(2)). There were 14 cases in the venous supercharged group and 4 cases in the group without supercharge. The mean size of flaps in the venous supercharged group was significantly larger than that in the group without supercharge (22.6 ± 3.8 × 9.1 ± 1.7 cm vs. 17.5 ± 4.4 × 7.8 ± 1.7 cm, P = 0.03). Venous congestion occurred in all four flaps without supercharge that lasted 3-7 days and partial flap loss occurred in two cases. There was no early venous congestion and partial flap loss in supercharged flaps but venous congestion secondary to anastomotic occlusion developed in two cases. Early exploration with vein grafting resolved venous congestion in one case. Late exploration in the other resulted in flap loss. Preventive venous supercharge is suggested for the large, distally-based anterolateral thigh flap.

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A Modified Technique for Transposition of the Reverse Sural Artery Flap

Abstract: 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.

Cited by 32 publications

References 23 publications

The Distally Based Adipofascial Sural Artery Flap

The Distally Based Adipofascial Sural Artery Flap

Using the Pedicle Flap for Taking Pressure off the Pedicle in Distally Based Skin Flaps

The distally based, venous supercharged anterolateral thigh flap

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