Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients

Abstract

Background No large series have analysed distally based sural fasciocutaneous (DBSF) flaps in paediatric patients. The aims of this study were to assess the reliability and analyse the potential risk factors for these flaps and to describe complications in the donor site and the functional follow-up results. Methods Between June 2002 and November 2017, 88 DBSF flaps were used to reconstruct soft tissue defects in paediatric patients. Potential risk factors, reconstruction outcomes, and complications in the donor site of the flaps were analysed. Results Among the 88 flaps, partial necrosis developed in 8 flaps (9.1%). The partial necrosis rate was significantly higher in flaps with the top edge located in the 9th zone (26.1%), with a length-width ratio (LWR) ≥ 5:1 (28.6%), and with a dimension of the skin island ≥ 100 cm2 (22.7%). Partial necrosis did not occur in flaps with a dimension of the skin island < 80.0 cm2 or with a skin-island width < 7.0 cm. The reconstruction outcomes in most paediatric patients were evaluated as “excellent” or “good”. The incidence of obvious scarring was higher in the donor site. Conclusions Partial necrosis of DBSF flaps will significantly increase when the top edge of the flap is located in the 9th zone, when the LWR of the flap is ≥ 5:1, or when the dimension of the skin island is ≥ 100.0 cm2. Flaps with a skin-island width < 7.0 cm or with a dimension of the skin island < 80 cm2 are relatively safe and reliable.

Versatility of Reverse Sural Artery Flap for Coverage of Heel and Proximal Foot Defects in Children

“…The few valuable advantages of using this flap include simple and easy dissection technique, comparatively low morbidity at donor area and saving a major artery of the leg. 12 The sural nerve descends between the two heads of the gastrocnemius and penetrates the deep fascia at the junction of upper and middle-thirds of the leg. The nerve is accompanied by superficial sural artery.…”

Distally based sural flaps for soft tissue defects following traumatic osteomyelitis of lower leg and foot

“…In 1992, Masquelet et al 10 described the anatomical characteristics and clinical applications of the distally based sural ap, which has been widely used to reconstruct the lower leg and foot [11][12][13][14] . The distal sural ap combined with osteomyelitis treatment technology has been reported to treat traumatic osteomyelitis in the lower leg and foot with soft tissue defects 15,16 , while few reports have focused on a large sample and long follow-up period.…”