Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

Abstract

In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. The patient selection and surgical refinement are discussed. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at the Chang Gung Memorial Hospital. The defects were located at the ankle (three cases), foot (two cases), and heel (six cases). Particular attention was paid to precise patient selection and surgical refinements. Patient selection was based on the lower limb vascular status by palpable distal pedal pulses and ankle brachial index ranging from 0.9 to 1.2. Surgical techniques were refined as precisely locating the perforators of peroneal artery, placing the skin paddle in upper third of leg for a distal region coverage, designing a 7-cm-wide adipofascial pedicle with a 2 cm skin paddle on it, preserving the mesentery structure of sural nerve and concomitant artery with or without including gastrocnemius muscles cuff, no tunneling when inset this flap and supercharging with lesser saphenous vein whenever needed. All the flaps survived completely. Only one patient required immediate anastomosis of lesser saphenous vein to local vein around defect in order to relieve the venous congestion during operation. Patients felt diminished but adequate recovery of sense of touch and temperature at the flap. Following the precise patient selection and surgical refinements, the modified reverse sural flap seemed to be a reliable and effective local flap for reconstruction of the soft tissue defects on ankle and foot.

Reconstruction of distal lower extremities defect using the free peroneal artery perforator vessel based flap

“…Due to the limited mobility and availability of the overlying skin, even a small defect in the distal leg and foot region may require microsurgical reconstruction. There are many possible reconstructive options for this region, although all methods have specific limitations . With their considerable superiority over traditional conventional flaps in terms of decreased donor site morbidity, perforator flaps have become increasingly popular in reconstructive surgery in the last few decades.…”

“…There are many possible reconstructive options for this region, although all methods have specific limitations. [1][2][3][4] With their considerable superiority over traditional conventional flaps in terms of decreased donor site morbidity, perforator flaps have become increasingly popular in reconstructive surgery in the last few decades. The peroneal flap was first reported by Yoshimura et al in 1984.…”

A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles

“…Ideally, when tissue is lost, similar tissue should be used for reconstruction. Traditional treatment is to use pedicle skin flaps or local transposition flaps to repair soft tissue defects, but availability of local donor tissues is quite limited, especially at the foot and ankle [8][9][10][11]. Moreover, when bone or tendon is exposed with gross tissue loss, local flaps cannot provide coverage.…”

Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap

“…A large number of local flap methods related to reconstruction of the foot dorsum have been presented 24). Local flaps incorporating Z-plasty or V-Y plasty may also be applied, but these methods are not effective in the treatment of wide contractures.…”