The Distally Based Island Superficial Sural Artery Flap: Clinical Experience With 36 Flaps

Abstract

The principles of neurocutaneous flaps, first described by Masquelet in 1992, represented a new concept in skin vascularization. The distally based superficial sural artery flap is an example of this kind of flap, which is supplied by the vascular axis that accompanies the sural nerve. The authors treated 36 patients with 36 distally based superficial sural artery flaps. All flaps survived, but six of them exhibited partial necrosis. No patient experienced anesthesia of the lateral side of the foot or neuroma at the donor site 12 months after surgery. The authors confirmed that this flap is very useful for soft-tissue reconstruction of the distal third of the leg and foot. Additionally they conclude that the principal advantages are that the blood supply is reliable, execution is easy and fast, the operation can be performed under regional anesthesia, the flap has a large arc of rotation, direct closure of the donor area is possible for small flaps, major arteries or nerves are not sacrificed, and excellent durability is achieved, even on weight-bearing areas. The major drawback is the donor site scar.

Retalho sural estendido de pedículo distal

“…Desta forma, a maior parte dos autores restringem a confecção do retalho nos dois terços distais da perna [3][4][5][6][7][8] e, assim, este consegue alcançar apenas lesões do tornozelo e região posterior do calcanhar, não atingindo lesões mais distais no pé. As dimensões também são limitadas, o que dificulta seu uso em lesões extensas na região distal da perna.…”

“…As limitações iniciais eram em relação ao alcance e ao tamanho do retalho, pois, segundo os fundamentos teóri-cos, deveria ser feito nos dois terços distais da perna, onde o trajeto do nervo é suprafascial, não devendo estender a ilha de pele para o terço proximal [3][4][5][6][7][8] . Assim, alcançava-se com dificuldades o pé e não se conseguia tratar lesões muito extensas.…”

“…Esta diferença entre a teoria e a prática pode ser inclusive percebida em alguns artigos, onde os autores descrevem a confecção do retalho nos 2/3 inferiores, e as fotografias dos casos mostram a utilização também do 1/3 superior da perna [4][5][6]9,10 . Pretendemos neste estudo comprovar a possibilidade de confeccionar o retalho sural de pedículo distal utilizando a pele do terço proximal da perna, permitindo não só aumentar o seu tamanho, como também seu alcance distal.…”

Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels

“…The distally based neuro-fasciocutaneous flaps with blood vessel perforators are advantageous (Cavadas, 1997;Costa-Ferreira et al, 2001;Almeida et al, 2002;El-Shazly and Yassin, 2006;Afifi et al, 2008;Saint-Cyr et al, 2009) for lower limb reconstruction, especially for soft-tissue defects on the ankle and joints; however, necrosis of a part or most of the flaps usually occurs because of disturbances in venous drainage. To resolve this problem, several researchers have adopted the "anastomosed superficial venous method" in distally based neuro-fasciocutaneous flaps and designed interesting ways of transferring the flap to prevent pedicle distortion and compression.…”

The Sural Artery Island Flap in Salvage of a Prosthetic Ankle Joint

“…The largest flaps that have been documented by various authors have however not exceeded 15 cm in length [4][5][6][7][8][9]. These flaps have been mainly used for soft tissue and skin defects around the ankle region caused by trauma, pressure sores, melanoma excisions and electrical burns.…”