Reverse Sural Artery Flap for the Reconstruction of Chronic Lower Extremity Wounds in High-Risk Patients

Influence of flap factors on partial necrosis of reverse sural artery flap

“…Reverse sural artery flap was regarded as a type A fasciocutaneous flap by Morgan et al, 6 but we think that the flap in this study should belong to a type B fasciocutaneous flap according to the classification introduced by Cormack and Lamberty, 20 because there is a single sizeable fasciocutaneous perforator of peroneal artery contained at the base of adipofascial pedicle of the flap. The flaps harvested in this study are similar to perforator-plus fasciocutaneous flap described by Mehrotra 21 and peninsular pedicled peroneal arterial perforator flap described by Lu et al 22 The flaps have characteristics of both perforator flaps and fasciocutaneous flaps in which LWR plays an important role in viability of the flaps.…”

Negative pressure wound therapy for the management of flaps with venous congestion

“…In the available literature, the duration of this therapy ranged from 4 days in random local flaps to 17.75 days. [26][27][28] Among the patients enrolled in this report, 3 out of 12 (25%) received blood transfusion. Previous comorbidities and protracted operating time might have contributed the blood loss in these patients.…”

“…With respect to the few studies focused specifically on the improvement of flap survival using NPWT, the optimal negative pressure has been variable. In particular, Morgan et al reported the failure of two flaps using 125 mmHg, whereas with 100 mmHg, no complications were observed . Another study set the pressure so that the systemic systolic pressure was always greater than the NPWT and they used continuous negative pressure at 75 mmHg while other authors recommend a continuous suction at 120 mmHg .…”

“…Prior to NPWT removal, normalization of blood puncture test and clinical absence of congestion should be confirmed. In the available literature, the duration of this therapy ranged from 4 days in random local flaps to 17.75 days …”

“…In particular, Morgan et al reported the failure of two flaps using 125 mmHg, whereas with 100 mmHg, no complications were observed. 27 Another study set the pressure so that the systemic systolic pressure was always greater than the NPWT and they used continuous negative pressure at 75 mmHg while other authors recommend a continuous suction at 120 mmHg. 28 Further studies with more cases and matched controls are warranted to clarify the recommended pressure range for congested flaps.…”