Lower Leg Reconstruction Using a Sural Fasciocutaneous Flap

Satoh, Kaneshige; Fukuya, Fumihiko; Matsui, Atsuo; Onizuka, Takuya

doi:10.1097/00000637-198908000-00001

Cited by 48 publications

(15 citation statements)

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“…Other examples cited in the literature include the reverse sural artery flap 27 and its lateral variant flap, the medial sural artery perforator flap, 28 the saphenous artery, and reversed flow saphenous island flaps. 29 Flap elevation requires a detailed knowledge of the main vessel's course and its possible anatomical variations and dissection around the vessel can be time-consuming.…”

Section: Discussion Flap Options For the Ankle And Achilles Regionmentioning

confidence: 99%

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

2008

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Section: Discussion Flap Options For the Ankle And Achilles Regionmentioning

confidence: 99%

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

2008

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“…In some cases, a free flap cannot be elevated because of the absence of a suitable pedicle. 6 Previous anatomical studies revealed variations in the origin of the median superficial cutaneous vessel, which arises from the popliteal artery in 65% of cases, from the medial sural artery in 20%, and from the lateral sural artery in 8.3%. It was also reported that the average diameter of the median sural artery is 1 mm and that of the lateral sural artery is 0.5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,9,10 The disadvantage of such a ''traditional'' posterior calf fasciocutaneous flap is its small diameter and the possible anatomical variations among pedicles. In some cases, a free flap cannot be elevated because of the absence of a suitable pedicle.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5 However, some authors do not recommend this flap for use as a free flap because of the smallcaliber pedicle and numerous anatomical variations. 6 Satoh et al 6 reported that no vessel was found in two of 17 cases. Shaw et al 7 reported that, in their clinical experience, there seemed to be an inverse relationship between the superficial cutaneous system and deeper systems of musculocutaneous perforators with respect to the blood supply to the posterior calf (see Fig.…”

mentioning

confidence: 98%

“…The medial sural (medial gastrocnemius) perforator free flap, which has a long and larger-caliber pedicle and can be elevated as a thin piece of tissue without any donor-site morbidity, is considered to be one of the best choices for reconstruction of a distal extremity or the head and neck region. [1][2][3][4][5] Previous anatomical studies have shown that 90% of limbs have the potential for elevation of this flap, whereas 10% of limbs do not have sufficient perforators for elevation of this flap.3 In the absence of medial sural perforators, use has been recommended of a traditional posterior calf fasciocutaneous flap, which is supplied by the median superficial or the lateral superficial sural arteries and can be elevated as a second choice at the same donor site.2,3,5 However, some authors do not recommend this flap for use as a free flap because of the smallcaliber pedicle and numerous anatomical variations.6 Satoh et al 6 reported that no vessel was found in two of 17 cases. Shaw et al 7 reported that, in their clinical experience, there seemed to be an inverse relationship between the superficial cutaneous system and deeper systems of musculocutaneous perforators with respect to the blood supply to the posterior calf (see Fig.…”

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confidence: 99%

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Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap

et al. 2009

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Three kinds of free fasciocutaneous flap from the posterior calf region have been described in the literature: the medial sural perforator flap, the lateral sural perforator flap, and the traditional posterior calf fasciocutaneous flap that is supplied by superficial cutaneous vessels. Moreover, it has been reported that superficial cutaneous vessels are of a suitable size for microanastomosis when deep musculocutaneous perforators are absent or relatively tiny. To establish a safe technique for free fasciocutaneous flap elevation from the posterior calf region, we examined the number and location of the musculocutaneous perforators and the size of superficial cutaneous vessels at their origin from the popliteal artery in six formalinized cadavers. We found that all legs had at least one perforator either from the medial sural artery or the lateral sural artery. By contrast, we failed to find superficial cutaneous vessels of suitable size for microanastomosis in three legs, and there was no significant inverse relationship between the diameter of the superficial cutaneous artery and the number of musculocutaneous perforators. Our results suggest that the medial sural perforator flap and the lateral sural perforator flap might be the surgeon's first and second choice, respectively. The traditional posterior calf fasciocutaneous flap should be the third choice because our study suggests that its availability is doubtful. Another site is recommended, when preoperative Doppler study suggests that the existence of musculocutaneous perforator is in doubt. Two clinical cases, with a medial sural perforator flap and a lateral sural perforator flap, respectively, are presented.

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Nerve sparing‐distally based sural flap

et al. 2011

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The management of soft-tissue defects in the ankle and foot area is a challenging task. Distally based sural flap is widely used, however it leaves donor area paresthesia. For this purpose, the sural nerve was dissected and preserved in the distally based sural flap in five cases of ankle and foot soft tissue reconstruction. This modification did not cause any compromise in flap circulation. All flaps survived with one partial distal necrosis. We suggest that, the distally based nerve sparing sural flap can be securely elevated with only a 3-4 cm wide subcutaneous pedicle without any compromise in flap circulation.

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Lower Leg Reconstruction Using a Sural Fasciocutaneous Flap

Cited by 48 publications

References 0 publications

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap

Nerve sparing‐distally based sural flap

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