The Distally Based Superficial Sural Artery Island Flap: Clinical Experiences and Modifications

Abstract

The coverage of defects of the Achilles tendon, malleoli, and heel remains a challenge to reconstructive surgeons. The distally based superficial sural artery island flap is vascularized by the median superficial sural artery, posterolateral septal perforators originating from the peroneal artery, neurovascular arteries of the sural nerve, and combinations of these systems as suprafascial plexus. We used distally based superficial sural artery island flaps for the reconstruction of defects of ankle, malleolus, and heel in 17 patients between 1991 and 1997. The largest flap we have used until today was 12 cm in width and 15 cm in length. All flaps have survived. However, we observed venous congestion and edema in two flaps. Also, marginal necrosis occurred in two flaps for which we had not taken the sural nerve with the flap. After these complications, we made some modifications. We left a skin extension over the fasciovascular pedicle and used it as a roof of the tunnel. We took the sural nerve and the deep fascia in all cases. The main advantage of this flap is a constant and reliable blood supply without sacrifice of a major artery. In addition, this is a one-stage, safe and easy procedure that can be used for large defects.

Retalho sural estendido de pedículo distal

“…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.…”

Supercharged reverse-flow sural flap: A new modification increasing the reliability of the flap

“…Thus larger flaps can be raised safely with this modification. In the first case, we elevated a sural flap measuring 15 · 12 cm safely, and it was the second largest flap in the literature, which was also performed by Yilmaz et al 9 To date, the largest flap raised suc- cessfully is 17 · 16 cm and belongs to Ayyappan and Chadha. 19 The other two sural flaps in this study were also quite large.…”

“…In the distal portion, a skin incision over the pedicle is performed to the pivot point, although the pedicle can be transferred with the skin bridge over itself. 9 The pedicle width should be 3À4 cm at least. While the pedicle can be tunnelized or exteriorized, we prefer to transport it via an incision between pivot point and defect.…”

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.…”