Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: experience of 109 clinical cases

Abstract

BackgroundSoft tissue defects over the mid- and distal third tibia, heel, dorsum and plantar aspect of the foot and over the medial, lateral and posterior aspect of the ankle are a common scenario in clinical orthopaedic practice. In this article, we describe the utility of the reverse sural fasciocutaneous flap with a cutaneous pedicle in 109 clinical cases with distal lower limb soft tissue defects.Materials and methodsA total of 109 patients were operated on for moderate (5–15 cm) and large (more than 15 cm) soft tissue defects at various sites along the lower limb including foot, heel and sole with the reverse sural fasciocutaneous flap. The defects were secondary to trauma (61 cases), diabetic ulcers (12 cases), post-traumatic scar contracture (8 cases), venous ulcer (4 cases), wound dehiscence (10 cases), leprotic non-healing ulcer (1 case), post-infective wound (1 case), radiation-induced ulcer following radiotherapy for synovial cell sarcoma (1 case), post-fibromatosis excision (1 case), post-dermatofibrosarcoma excision (1 case), post-heel melanoma excision (1 case) and actinomycosis foot (1 case). Patients were assessed for flap uptake and healing of defects.ResultsAmong the 102 cases analysed, 81 were male and 21 female with an average age of 32.7 years. The average size of the flaps was 148.10 ± 59.54 cm2. The flap healed uneventfully in 89.21 % of patients. Edge necrosis occurred in 9 cases. Donor site regrafting was required in 7 patients.ConclusionThe reverse sural fasciocutaneous flap with a cutaneous pedicle is a quick, versatile, easy and safe soft tissue defect coverage technique to cover most of the soft tissue defects of the lower limb in common orthopaedic practice and does not require any microvascular repair, though it may be cosmetically unappealing in a few cases.Level of evidenceIV (Case series)

Sural Neuro-Cutaneous Flap in the Management of Foot and Ankle Soft Tissue Defects in a Diabetic Population

“…Recently, the sural flap ( Fig. 1) has been advocated as a reliable flap to cover soft tissue defects in the general population [17,18].…”

Reconstruction of Hind and Mid-Foot Defects after Melanoma Resection Using the Reverse Sural Flap: A Case Series

“…When reviewing the available literature, we can find many authors who recommend the use of the reverse sural flap, 4,[6][7][8][9] while others inform poor results.…”

“…However, many articles report a high incidence of partial flap necrosis. [6][7][8] In addition to that, some authors believe that the reverse sural flap is not suitable for weight-bearing heel reconstruction due to the numbness of the heel induced by the harvest of the flap. This has not been a problem in our patients.…”

“…According to the literature, the reverse sural flap has been widely used for orthopedic or traumatic cases. 3,6 When malignant melanomas involve the foot, large defects are created after the tumor excision with wide margins. Different authors support the use of the reverse sural flap as a reconstructive alternative.…”

“…The optimal type of reconstruction should provide sufficient vital tissue with low morbidity and acceptable recovery of the foot function. There are many reports [2][3][4][5][6] that reveal the utility of the reverse-flow sural flap for the treatment of foot defects originated by traumatic events or diabetic foot and ulcerous disease. Despite many authors have addressed the use of these flaps as a reconstructive option for defects after melanoma excision, no large series have been reported for that purpose.…”