Distally Based Sural Flap in Children: Experience in Our Department

Abstract

The reverse sural artery flap (RSAF) was first described approximately four decades ago in 1983 by Donski and Fogdestam [1] and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Coverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in children, to get a global experience with the sural flap in our department of plastic and reconstructive pediatric surgery, and to describe the complications. Material and methods: A distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 5 paediatric patients between 2018 and 2021. The median age of patient at surgery was 6 years old. The most frequent mechanism of soft tissue defect was trauma caused by vehicular accident (open fractures) crush injuries, lacerated wound. Results: One of the 5 flaps was a cross leg sural flap, 4 recovered well without necrosis, only one developed partial necrosis requiring excision and skin grafting. The other complications where an early postoperative complications: partial or total necrosis of the flap late complications including impaired touch sensation over the flap and donorsite. Discussion: The distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a good blood supply. When there is exposure of a vital structure, distal sural flap is the best indication for coverage in a traumatic soft-tissue defect. The use of a distally based sural fascio cutaneous flap is not free from delayed complications most of them at the donor site.