Abstract:The flaps based on the vascular axis of superficial sensitive cutaneous nerves had gained increased popularity in reconstructive surgery because of such major advantages as preservation of major extremity arteries and avoidance of microsurgical procedures. However, postoperative venous congestion resulting in partial or total necrosis is still a common problem for these flaps. The aim of the current study is to introduce a new method for reducing the postoperative venous congestion of neural island flap with t… Show more
“…In total, 33 studies met the inclusion criteria and were subject to quantitative analysis. 12,14,15,18 -47 Only one study had a comparative design 15 ; all others were case-series. Figure 3 shows the flowchart of the search strategy.…”
Section: Resultsmentioning
confidence: 99%
“…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 -32,34 -36,39,41,45,47…”
Section: Resultsmentioning
confidence: 99%
“…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. 12,15,19,[21][22][23][26][27][28][29][30][31][32][33][34][35][37][38][39][42][43][44]46,47 Of 174 flaps reporting detailed surgical technique, only 45 (25.8%) tunneled their pedicle subcutaneously.…”
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.
“…In total, 33 studies met the inclusion criteria and were subject to quantitative analysis. 12,14,15,18 -47 Only one study had a comparative design 15 ; all others were case-series. Figure 3 shows the flowchart of the search strategy.…”
Section: Resultsmentioning
confidence: 99%
“…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 -32,34 -36,39,41,45,47…”
Section: Resultsmentioning
confidence: 99%
“…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. 12,15,19,[21][22][23][26][27][28][29][30][31][32][33][34][35][37][38][39][42][43][44]46,47 Of 174 flaps reporting detailed surgical technique, only 45 (25.8%) tunneled their pedicle subcutaneously.…”
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.
“…Furthermore, it is well known that flaps with arterial insufficiency (ischemia) recover more rapidly than flaps with venous stasis (congestion) when reperfusion is performed, suggesting that the flap is more susceptible to congestive than ischemic stress. 9 , 10 , 11 , 12 Figure 2 The picture shows an harvested gastric tube, and arrows indicate mesenteric veins. The more distal (head side) the gastric tube is, the more dilated the veins are and the darker the gastric tube is.…”
“…12 While using an internal vein stripper can destroy the competency of potentially obstructive valves in the lesser saphenous vein, other techniques have been reported to bypass them altogether. 34 The inclusion of a cuff of gastrocnemius muscle from the deep midline during flap harvest has been reported to improve venous drainage by utilizing musculocutaneous perforators as an additional bypass pathway. 24 Systematic analysis found this method to have a 2.6% total failure and a 5.2% complication rate with no significant improvement compared with the classic flap (p ¼ 0.65 and p ¼ 0.70, respectively).…”
Coverage of posttraumatic and chronic wounds at the distal leg is a difficult problem due to limited soft tissue available for local flaps. The sural flap is a versatile and effective method for reconstruction in this area since it does not need a significant amount of time or assistance to complete. Improving the survival of these flaps is critically dependent on understanding the basics of flap circulation and why recent modifications were introduced. This review will serve as a much-needed comprehensive analysis of these topics for surgeons looking to increase the reliability of their sural flaps.
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