Reverse sural artery fasciocutaneous flap cover for soft tissue defects in distal one third of leg, ankle and foot in a tertiary care center

Abstract

Background: Soft tissue defect management around the lower-third of the leg, ankle and dorsal feet with exposed tendons, bones and orthopaedic implants is a challenge faced by a majority of surgeons. A locally available, versatile, durable flap is the preferred option for coverage of such defects, in the absence of micro vascular surgery facility.Methods: This prospective study was conducted at Department of General Surgery, Kodagu Institute of medical sciences from March 2018 to May 2019, on 10 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested moderate sized reverse sural artery flaps, to cover the defects. After perforator marking with Doppler, flap was planned in reverse, and procedure was performed. Factors like size of defect, flap size, width of pedicle, comorbid factors and complications following surgery were taken into account for the study.Results: A majority of flaps provided a good coverage for defects and graft was well taken in donor site in all cases. One patient had marginal flap necrosis who was elderly and diabetic, he was managed conservatively, another patient had distal flap venous congestion which settled by itself with conservative management.Conclusions: Reverse sural artery flap (RSAF) cover is versatile, reliable and safe procedure, which was efficiently used to treat patients with wounds of distal leg, and foot.