The Clinical Outcome of Perforator Based Sural Artery and Propeller Flaps in Reconstruction of Soft Tissue of Extremities

Abstract

BACKGROUNDThe reconstructive options for the soft tissues in extremities present serious challenges due to thin non-expendable soft tissues and predisposition to massive edema formation, thus frequently requiring flap cover. This study was undertaken to assess the outcome of a modified version of the sural artery flap with that of propeller perforator flaps for the reconstruction of lower extremities, particularly the heel defects. METHODS This prospective study was conducted on 40 consecutive patients, of which 20 treated with sural artery flap and another 20 with perforator based propeller flap cover for soft tissue reconstruction in extremities based on predefined inclusion criteria. The clinical outcome of the flap was assessed after three months. RESULTSInclusion of the posterior tibial perforators (along with the sural artery and the peroneal artery) was shown to enhance the flap territory. The raising of the flap was quick with minimal blood loss and the modified flap had a wide arc of rotation for reconstruction of the heel defects. The younger patients regained sensation on the flap earlier, while the durability of the fasciocutaneous flap was excellent in the heel weight bearing areas. The success rate was 95% flap take. CONCLUSION Careful selection of the perforator and optimal designing of the flap result in favorable outcomes with the use of local perforator flaps for reconstruction in extremities. It provides predictable clinical outcomes with minimal donor site morbidity, is costeffective, relatively easy technique and requires no special microsurgical setup or instruments.

A Single-Center Surgical Experience With the Reverse Sural Artery Flap as a Reliable Solution for Lower Leg Soft Tissue Defects, With Minimum Two-Year Follow-Up

“…Schaverien and Saint-Cyr examined peroneal perforators and found that are randomly distributed and can be found at any level, making careful dissection mandatory, in order to identify a proper vascular source for the flap [18]. Most authors, however, advocate the use of pre-operative Doppler ultrasound to ensure adequate flap vascularity [2,[19][20][21][22]. In our practice, the flap pedicle must be at least 4 cm wide in order to secure adequate arterial supply and venous drainage.…”

A novel negative pressure wound therapy (NPWT) monitoring system for postoperative flap management

“…[2][3][4][5] Various types of flaps are commonly used as reconstructive options for patients with soft tissue defects, and the survival rate of the flaps may reach 90% to 95% in free flap and 80.7% to 95% in pedicled or perforator flaps. [6][7][8] The postoperative monitoring procedure is crucial for increasing the success rate of flap surgery. However, the monitoring of the flap still requires a large amount of time and effort.…”

Versatility of Reverse Sural Artery Flap (RSAF) in management of lower limb defects: Our experience

“…Reverse Sural artery flap is a distally based fasciocutaneous flap [1,2] . It is based on peroneal artery perforators and anastomosis between the peroneal artery septocutaneous perforator and sural arterial network [3,4,5] . It does not involve sacrificing any major vessel of limb.…”