The reverse sural artery flap for the reconstruction of distal third of the leg and foot

Abstract

Soft tissue defects around the distal third of the leg and the foot present a major reconstructive challenge. There is limited expertise with free tissue transfers in many developing countries, necessitating consideration of other options for the closure of such defects. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. Twenty patients comprising of 13 males and 7 females with soft tissue defects of the lower third of the leg and foot requiring soft tissue cover were treated between January 2006 and December 2010. The age range was 7-58 years with a mean age of 30 years. Nineteen (95%) of the defects were post-traumatic while one (5%) was post-infective. All the defects were covered with reversed sural artery flaps, which were raised on the posterior aspect of the junction of the upper and middle third of the leg. The smallest flap was 4 × 4 cm(2) while the largest measured 20 × 12 cm(2). The donor defect was closed directly in 7 (35%) patients, while split skin graft was applied in the remaining 13 (65%) patients. There was satisfactory flap healing in 17 patients (85%), while 3 patients (15%) had complete flap necrosis. Two of these patients had significant comorbidities of haemoglobinopathy and poorly controlled diabetes mellitus. Sural artery flap remains a viable option for the reconstruction of soft tissue defects of the distal third of the leg and foot. Caution should, however, be exercised in patients with some significant systemic diseases.

Propeller flap for complex distal leg reconstruction: A versatile alternative when reverse sural artery flap is not feasible

“…Many authors prefer the use of reverse sural artery flap for the reconstruction of the distal lower limb where feasible because of the disadvantages associated with free flap. [ 5 ] A local perforator-based propeller flap equally offers these same benefits over free flap, in addition to ease and speed of harvest, easy learning curve; closer and supple match and above all affordability in our setting.…”

“…There is an increase in the incidence of such defects in our practice setting due to change in the mode of commercial transportation and security challenges. [ 5 ] The distal leg is often a target of gunshot by an attacker without intent to kill. [ 10 ] Our patients belong to this group.…”

“…The two patients that we presented both sustained injury to the sural artery and therefore the use of reverse sural artery fasciocutaneous flap recommended as a simple flap for reconstruction of soft tissue defect of the distal third of lower limb was not possible. [ 2 5 ] As stated by Pirwani et al[ 2 ] that irrespective of etiology, coverage of exposed soft tissue done in time is mandatory and essential for prevention of complications. It is a practice in our department to reconstruct soft tissue defect early except otherwise indicated.…”

“…Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects in settings with limited resources. [ 5 ] Its use obviates the need for sophisticated equipment, extended operative time, and super specialized training. Revere sural artery flap is a relatively easy and fast method of transferring a large amount of tissue.…”

Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

“…However, a select few centres in LMICs are undertaking these procedures as part of standard practice (15)(16)(17). Local and regional alternatives do exist, however many of these are also technically demanding, and even with extensive training, microsurgical equipment and techniques, they are vulnerable to complications requiring further surgery (18)(19)(20)(21). However, there is also some data in support of successful local reconstructive alternatives being used effectively in low-resource contexts (21).…”