Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft

Chi, Zhenglin; Chen, Yiheng; Chu, Tinggang; Gao, Weiyang; Li, Zhijie; Yan, Hede; Song, Ying

doi:10.1016/j.bjps.2017.10.021

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…The remaining 28 studies with 167 patients reported the site of the wounds: 95 at posterior ankle/heel, 18 at dorsal/plantar midfoot, and 43 at the ankle region. 12,14,15,[18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37][38]41,[43][44][45][46][47] Diabetes duration was not reported in most studies. Most studies did not report ulcer duration while many emphasized on the chronicity of the included wounds, most resistant to topical management.…”

Section: Patient and Ulcer Characteristicsmentioning

confidence: 99%

“…Nine studies reported the defect size to be covered with a mean size of 47.7 + 21.7 cm 2 . 15,20,22,27,37,38,43,46,47 Seventeen studies reported the flap area with a mean size of 50.4 + 28.62 cm 2 . 14,18,19,21,23,26,[29][30][31][32][34][35][36]39,41,45,47 Twenty-four studies reported the mean width of their flap pedicles with a pooled mean width of 3.56 + 1 cm.…”

Section: Flap Characteristicsmentioning

confidence: 99%

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Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

et al. 2021

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Background: The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ankle ulcers. Methods: A systematic review was undertaken from MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Only diabetic foot and ankle ulcers were accepted for inclusion and all study designs were included. Proximally based flaps, nondiabetic ulcers, and assisted negative pressure therapy were excluded. Suitability for inclusion was assessed by 2 reviewers. The random-effect estimate was reported for the set outcomes whenever high heterogeneity was present. Metaregression analysis was performed to identify independent risk factors for failure. Results: The search identified 33 relevant studies comprising 187 patients and flap interventions; all but 1 were case-series. The weighted outcomes were as follows: (1) the flap healing rate was 93.3% while 6.6% resulted in total necrosis, (2) the rate of partial flap necrosis was 12%, (3) venous congestion was reported in 6.6% of cases, (4) the infection rate was 8.3%, and (5) the donor site morbidity was 4.6%. No association was found between pedicle width or presence of a subcutaneous pedicle tunnel and the primary outcome of total loss. Conclusions: This review demonstrated excellent results of the flap when covering complicated or large diabetic foot and ankle ulcers. When compared to those published in the literature, our results found RSFCF to be relatively less successful in diabetic wounds than in trauma patients but more successful than in those having associated osteomyelitis and those who were treated with random local flaps.

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Section: Patient and Ulcer Characteristicsmentioning

confidence: 99%

Section: Flap Characteristicsmentioning

confidence: 99%

Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

et al. 2021

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“…Recent studies have investigated morbidity at the donor site and the complications caused by flap harvest. To reduce the size of the donor site and prevent morbidity, Chi et al [ 14 ] introduced a modified flap with a narrow pedicle and presented a method for donor site coverage with a local relaying island flap based on a perforator without an STSG. Despite these efforts, skin grafts are inevitably needed to cover large donor sites.…”

Section: Introductionmentioning

confidence: 99%

Resurfacing the donor sites of reverse sural artery flaps using thoracodorsal artery perforator flaps

Park

Kim

2021

Arch Plast Surg

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Background The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps.Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases).Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021).Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

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“…Since Masquelet et al 1 reported details about the use of a sural fasciocutaneous flap, the flap has become a mainstay in reconstructive surgery. [2][3][4][5][6] At present, the scope of reconstruction using a distally based sural fasciocutaneous (DBSF) flap is still controversial. [7][8][9][10] In the previous literature, some authors considered the pivot point of the DBSF flap should be designed to be >5 cm above the lateral malleolus, and the top edge of the DBSF flap should not reach the upper one-third of the lower leg.…”

Section: Introductionmentioning

confidence: 99%

Distally Based Sural Fasciocutaneous Flaps for Reconstructing Soft Tissue Defects Proximal and Distal to the Tarsometatarsal Joints: A Comparative Analysis

Luo

et al. 2021

The International Journal of Lower Extremity Wounds

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Distally based sural fasciocutaneous (DBSF) flaps are widely used for reconstructing soft tissue defects of the foot. The purpose of this paper was to compare the clinical efficacy of the use of flaps to repair defects in areas proximal and distal to the level of the tarsometatarsal joints in a relatively large number of patients and to analyze the effects of factors on the risk of developing partial necrosis of the flaps. Between April 2001 and December 2019, a total of 355 DBSF flaps were utilized to cover soft tissue defects in the foot. According to the furthest location of the defects reconstructed with the flaps, the flaps were divided into the proximal foot group (n = 260) and the distal foot group (n = 95). The partial necrosis rates, their influencing factors, and the clinical outcomes of the procedure were compared between the two groups. In the proximal foot group, the partial necrosis rate (6.2%, 16 of 260) was significantly lower than that in the distal foot group (14.7%, 14 of 95) ( P < .05). The proportion of successful coverage of the defects using the flaps alone or in combination with a simple salvage treatment was comparable between the groups ( P > .05). The ratio of unfavorable conditions in the distal foot group was higher than that in the proximal foot group ( P < .05). DBSF flaps can be effectively utilized to repair defects in the proximal and distal areas of the foot. The use of a DBSF flap to repair defects in the proximal areas of the foot is superior to the use of DBSF flaps for repairing defects in the distal areas of the foot in terms of reliable survival of the flap.

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Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: Surgical modifications for flap pedicle and donor site closure without skin graft

Cited by 15 publications

References 30 publications

Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

Resurfacing the donor sites of reverse sural artery flaps using thoracodorsal artery perforator flaps

Distally Based Sural Fasciocutaneous Flaps for Reconstructing Soft Tissue Defects Proximal and Distal to the Tarsometatarsal Joints: A Comparative Analysis

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