Reverse sural flap with an adipofascial extension for reconstruction of soft tissue defects with dead spaces in the heel and ankle

Li, Zheng; Zheng, Judun; Dong, Zhonggen

doi:10.1007/s00068-015-0569-x

Cited by 14 publications

(16 citation statements)

References 36 publications

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“…The demand of local tissue for bearing significant body weight makes it a unique tissue, thus local flaps are good and viable options. Reverse sural artery flap, 5 medial plantar artery flap, or peroneal perforator artery flaps 6 are viable local options, each having pros and cons of the procedure. 7…”

Section: Discussionmentioning

confidence: 99%

Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel

Khan

Beg

Obaid-ur-Rahman

2018

Plastic and Reconstructive Surgery - Global Open

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Background:Soft-tissue coverage is a challenge to the ankle and foot reconstructive surgeon due to its unique requirement of simultaneously withstanding body weight and to provide sensory feedback. We share our experience of medial plantar artery perforator (MPAP) flap, which provides a robust sensate coverage to heel defects.Methods:Three-year retrospective study, which included soft-tissue injury to heel. All patients underwent MPAP flap for the coverage of the defect. Patients' demographic, mode of injury, defect size, flap size and survival, time to start weight bearing, return of protective sensations, and comparative 2-point discrimination with opposite heel were studied.Results:We studied 16 cases with heel soft-tissue injuries. Fifteen had motor vehicle accident, and 1 had chronic diabetic wound. Mean surface area of flap was 4 × 5 cm. Except 1 flap, 15 flaps had complete survival and provided reliable wound coverage with comparable normal sensation as on other foot.Conclusion:We suggest that MPAP flap, when available, is a good local tissue for heel wounds coverage.

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Section: Discussionmentioning

confidence: 99%

Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel

Khan

Beg

Obaid-ur-Rahman

2018

Plastic and Reconstructive Surgery - Global Open

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“…[18]. Reverse sural artery flaps [19], medial plantar artery perforator (MPAP) flap, or peroneal perforator artery flaps [20] are viable local options. Of course, each procedure and each flap has its pros and cons [20].…”

Section: Discussionmentioning

confidence: 99%

“…MPAP flaps are especially suitable for these reconstructions because of the use of thick, glabrous skin and its sensory feedback [18]. Besides the hind foot, this flap can also be a good option for the reconstruction of mid-and fore foot defect [18][19][20]. Several aspects make the use of MPAP flaps difficult: (1) difficulty of dissection, and (2) the long learning curve to fully master this surgical technique [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Besides the hind foot, this flap can also be a good option for the reconstruction of mid-and fore foot defect [18][19][20]. Several aspects make the use of MPAP flaps difficult: (1) difficulty of dissection, and (2) the long learning curve to fully master this surgical technique [18][19][20]. One of the advantages over, for example, the reverse sural artery flap, is that the MPAP flap gives sensory feedback due to the sensate skin fulfilling local demands [18,19].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Challenges in Resection and Reconstruction of a Verrucous Carcinoma of the Right Calcaneus With a Medial Plantar Artery Perforator Flap: A Case Report

Jongh¹,

Pouwels²,

Marinelli³

et al. 2021

Cureus

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A verrucous carcinoma is a rare, low-grade variant of a well-differentiated squamous cell carcinoma (SCC). It frequently occurs in Caucasian males aged 50 to 60. The tumour is locally destructive, grows into muscle, nerves and bones, but rarely metastasizes. Here we report a patient with verrucous carcinoma on the right calcaneus with the uncommon symptom of a haemorrhagic plaque at the centre and also an exophytic component. A 52-year-old man presented with a 10-year-old, progressive, painful, pruritic, exophytic growing, hyperkeratotic and haemorrhagic plaque of 5.2 x 3.5cm on the right calcaneus. The lesion emerged after extensive burns after blast trauma as a child. Excisional biopsy with 2mm margin in combination with clinical presentation favoured a verrucous carcinoma. The pathology report showed that the tumour was not excised radically; therefore, re-excision with 5mm margin was required and was performed two months later. The wound was closed with a medial plantar artery perforator (MPAP) flap. The donor site was closed with a full-thickness skin graft (FTSG) from the medial side of the right upper leg and was covered by a tie-over bandage. Verrucous carcinoma is a rare tumour and can be adequately surgically treated by excision with clear margins. In this case, the verrucous carcinoma of the right calcaneus was excised and reconstructed with an MPAP flap with decent results, despite a challenging postoperative course.

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“…Since the anatomy and clinical application of the sural neurocutaneous flap were reported by Masquelet et al in 1992, 14 this flap has gradually become a mainstream for repairing soft tissue defects in the lower leg, foot and ankle. [15][16][17] The reversal sural flap has advantages of simple process, no need of vascular anastomosis, reliable blood supply and high survival rate. 18,19 This study aims to describe the use of the composite sural neurocutaneous flap with gastrocnemius tendon for simultaneously repairing the combined loss of Achilles tendon and regional soft tissues.…”

Section: Introductionmentioning

confidence: 99%

Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue

Zhou

Wei

Tao

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Defect of Achilles tendon and overlying soft tissue remains a surgical challenge due to its insufficient blood supply and high requirement of function. This study aims to report the clinical efficacy of the composite sural neurocutaneous composite flap with gastrocnemius tendon on the complicated defect of Achilles region. Methods: Seven cases of defects of Achilles tendon and overlying soft tissue were reconstructed by the composite sural neurocutaneous composite flaps with gastrocnemius tendons. It is important to keep the connection between gastrocnemius tendon and deep fascia of the composite flap during operation. The smallest and the largest areas of transferred skin flaps were 7.5 cm × 4.5 cm and 11 cm × 10 cm respectively. The size of gastrocnemius tendon ranged from 5 cm × 3 cm to 9 cm × 4 cm. Patients was evaluated by using the Arner-Lindholm scale at the last follow-up. Results: Six flaps survived completely with no complication. One flap developed wound dehiscence and went on to heal by daily dressing. With 12–60 months follow-up, all patients gained satisfactory appearance and function of ankle, without tendon re-rupture or recurrent infection. Based on Arner-Lindholm scale, six cases were noted to be excellent and one was good. Conclusion: The composite sural neurocutaneous flap with gastrocnemius tendon is a viable and practical method to salvage Achilles tendon defect and overlying soft tissue coverage, with minimal adhesion and satisfactory function.

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Reverse sural flap with an adipofascial extension for reconstruction of soft tissue defects with dead spaces in the heel and ankle

Cited by 14 publications

References 36 publications

Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel

Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel

Clinical Challenges in Resection and Reconstruction of a Verrucous Carcinoma of the Right Calcaneus With a Medial Plantar Artery Perforator Flap: A Case Report

Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue

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