Should We Hesitate to Use Subcutaneous Tunneling for Fear of Damaging the Sural Flap Pedicle?

Uygur, Fatih; Evinc, Rahmi; Noyan, Nurettin; Duman, Haluk

doi:10.1097/sap.0b013e318184aba2

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…We believe that it is the critical stage of transferring the pedicled flaps. 37 The subcutaneous tunnel should be a sufficient size, so that it is as wide as possible and the potential risk of hematoma caused by external pressure should be avoided. In two of our cases, we encountered temporary venous congestion in the early postoperative period, probably due to slight pedicle traction.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

Uygur

Sever

Tuncer

et al. 2009

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

Uygur

Sever

Tuncer

et al. 2009

Plastic and Reconstructive Surgery

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“…The skin condition under the tunnel, thickness and size of the pedicle and flap as well as the rotation arch, should be considered before making a decision on the flap placement method. Many authors believe that subcutaneous tunnelling is a safe procedure unless there is a presence of comorbidities 14,26,27 . Additional skin extension of the distal part of the pedicle, which we performed in some cases, can reduce the pressure on the neurovascular bundle.…”

Section: Discussionmentioning

confidence: 99%

Neurocutaneous flaps for soft tissue reconstruction of the knee, lower leg, ankle and foot: Clinical experience with 32 patients

et al. 2019

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Background/Aim. Neurocutaneous flaps (NF) are the type of fasciocutaneous flaps whose clinical application has increasingly grown over the years. They have become an indispensable step in the reconstructive ladder for the small and medium soft tissue defects of the lower leg and foot. The aim of this study was to analyse the results of the treatment of patients with lower extremity soft tissue defects caused by trauma, infection, tumour removal or unstable scar formation, which were reconstructed with a variety of NF. Methods. This retrospective study includes 32 consecutive patients with soft tissue defects of the lower limb, treated in the Clinical Centre of Vojvodina from January 2004 to April 2017. All the operations were performed in regional anaesthesia with pneumatic tourniquet. Design of the flap and length of the pedicle were determined by the size and position of the recipient site after necessary debridement. The flap was harvested, rotated and positioned in the defect region. The patients and flap data were summarized upon their collection. Results. The average age of the patients, mostly males (81.2%), was 46.7 years. Distally based sural flaps were used in a majority of patients (56.2%), followed by the distally based saphenous (21.9%), lateral sural (12.5%) and proximally based sural flaps (9.4%). Defects were most often localized on the distal third of the lower leg and on the ankle (53.1%). The most common indication for surgery were trauma (46.9%) and chronic infection (31.2%). A satisfactory coverage of the defect was achieved in all 32 patients with no flap loss. A partial necrosis of the flap due to prolonged venous congestion was noted in 3 (9.4%) patients, which were healed by second intention or with delayed skin grafting. Five (15.6%) patients developed a localised infection. The infection signs withdrew spontaneously in 2 cases and after a surgical revision in 3 cases, where osteitis of the tibia had persisted. One of them required the Ilizarov orthopaedic procedure after bone resection. Conclusion. NF proved to be a paramount alternative to free-flap reconstruction of the lower limb. Intensive clinical application can be explained by the fact that it is a less technically demanding and time consuming surgical procedure with no major source vessel sacrifice. The reliability and safety of their utilisation are confirmed by our clinical data.

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“…Reverse fasciocutaneous sural flap is one of the most useful local flaps in reconstructing the defect over foot and ankle caused by traumatic injury, chronic wounds, and osteomyelitis or burn scar contracture . The advantages include easy and fast harvesting without the need of complex microsurgical skills which results in a relatively short operation time, one‐stage operation that shortens the hospitalization stay and no major artery sacrifice because the circulation is based on the interconnection from perforators of peroneal artery to accompanying vessels of LSV and sural nerve.…”

Section: Discussionmentioning

confidence: 99%

“…However, the disadvantage is that it sometimes results in inevitable partial or total flap necrosis. Uygur et al considered subcutaneous tunneling as quite safe unless there were risk factors such as arterial HTN, diabetes, peripheral vascular disease, and vasculitis. However, there were still two patients who presented with partial flap necrosis.…”

Section: Discussionmentioning

confidence: 99%

Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

et al. 2013

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In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. The patient selection and surgical refinement are discussed. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at the Chang Gung Memorial Hospital. The defects were located at the ankle (three cases), foot (two cases), and heel (six cases). Particular attention was paid to precise patient selection and surgical refinements. Patient selection was based on the lower limb vascular status by palpable distal pedal pulses and ankle brachial index ranging from 0.9 to 1.2. Surgical techniques were refined as precisely locating the perforators of peroneal artery, placing the skin paddle in upper third of leg for a distal region coverage, designing a 7-cm-wide adipofascial pedicle with a 2 cm skin paddle on it, preserving the mesentery structure of sural nerve and concomitant artery with or without including gastrocnemius muscles cuff, no tunneling when inset this flap and supercharging with lesser saphenous vein whenever needed. All the flaps survived completely. Only one patient required immediate anastomosis of lesser saphenous vein to local vein around defect in order to relieve the venous congestion during operation. Patients felt diminished but adequate recovery of sense of touch and temperature at the flap. Following the precise patient selection and surgical refinements, the modified reverse sural flap seemed to be a reliable and effective local flap for reconstruction of the soft tissue defects on ankle and foot.

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Should We Hesitate to Use Subcutaneous Tunneling for Fear of Damaging the Sural Flap Pedicle?

Abstract: We concluded that unless there are certain risk factors such as arterial hypertension, diabetes, peripheral vascular disease, and vasculitis, avoiding a subcutaneous tunneling is not necessary.

Cited by 10 publications

References 27 publications

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

Neurocutaneous flaps for soft tissue reconstruction of the knee, lower leg, ankle and foot: Clinical experience with 32 patients

Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

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