The Distally Based Adipofascial Sural Artery Flap

Schmidt, Karsten; Jakubietz, Michael G.; Djalek, Stefanie; Harenberg, P.S.; Zeplin, Philip H.; Jakubietz, Rafael G.

doi:10.1097/prs.0b013e3182589b0e

Cited by 36 publications

(17 citation statements)

References 19 publications

(23 reference statements)

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“…Many different modifications of the sural flaps have been made based on its vascular pedicle and flap components [31,32] . …”

Section: Flap Variationsmentioning

confidence: 99%

Distally based perforator sural flaps for foot and ankle reconstruction

Chang

2015

WJO

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Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chainlinked adipofascial neurovascular axis around the sural/ saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

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“…Many different modifications of the sural flaps have been made based on its vascular pedicle and flap components [31,32] . …”

Section: Flap Variationsmentioning

confidence: 99%

Distally based perforator sural flaps for foot and ankle reconstruction

Chang

2015

WJO

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“…Although the supercharging technique changes the operation into a more complex microsurgical demanding procedure, the adipofascial technique requires no further skills and is less time-demanding than the classic RSAF. 5 All other modifications showed less improvement compared to the total rates. The venous supercharged flap design was the only modification that reached a statistically relevant difference to the unmodified RSAF in complication rate.…”

Section: Discussionmentioning

confidence: 92%

“… 1 , 2 , 3 , 4 In comparison to more demanding microsurgical free flaps, a common practice used for similar indications, the RSAF bears several advantages, including low donor site morbidity and a shorter operative duration. 5 Furthermore, this technique can be sufficiently adapted and performed by less experienced microsurgeons. Multiple studies reported excellent outcomes for the RSAF; however, discussion includes an uncertainty with the safety of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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The reverse sural artery flap– How do modifications boost its reliability? A systematic analysis of the literature

Schmidt¹,

Jakubietz²,

Meffert³

et al. 2020

JPRAS Open

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The reverse sural artery flap (RSAF) was first described approximately four decades ago and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Although the popularity of this flap never reached the extent of that of free perforator flaps, it still serves as a reliable alternative. This has been demonstrated by the increased rate of publication on the technique in recent years. The number of authors reporting data has risen up to 20 reports a year. During this time, several new modifications of the flap were inaugurated in order to boost the efficiency and reliability of the flap. The goal of this systematic analysis of the literature was to gain information on the influences of the modifications of the RSAF with regard to consistency and complication rates. An overall survival rate of 95% and a rate of complications of 14% were reported in all the analyzed cases. Some modifications were able to improve flap viability but not at a statistically significant extent. Venous supercharging and the adipofascial variant of the RSAF provided the best results. The RSAF is still a remarkable flap design, especially as a backup solution or in circumstances without a microsurgical skilled surgeon. Further investigation with controlled randomized prospective trials is vital to confirm this finding with more evidence.

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“…Furthermore, the flap is simple to harvest, and can be performed by a single surgeon in under 2 hours. A comparative study supports these advantages and illustrates the adipofascial flap to be as safe as the fasciocutaneous flap [13]. …”

Section: Discussionmentioning

confidence: 98%

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

2014

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BackgroundThe distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot.MethodsThe posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve.ResultsFrom the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle.ConclusionsThe distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

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The Distally Based Adipofascial Sural Artery Flap

Abstract: Therapeutic, III.

Cited by 36 publications

References 19 publications

Distally based perforator sural flaps for foot and ankle reconstruction

Distally based perforator sural flaps for foot and ankle reconstruction

The reverse sural artery flap– How do modifications boost its reliability? A systematic analysis of the literature

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

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