Role of Reversed Sural Artery Flap in Reconstruction of Lower Third of the Leg, Ankle and Foot Defects

DOI: 10.4236/mps.2018.83007   PDF   HTML   XML   1,288 Downloads   2,340 Views  

Abstract

Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive prcedure. Free tissue transfer remains the standard for the management of these defects. However, there are some disadvantages like; longer operative times, bulky contour, and the need for highly skilled expertise. The reverse superficial sural artery flap (RSSAF) is a distally based fasciocutaneous or adipo-fascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Methods: Twenty RSSAF flaps were harvested for reconstruction of different traumatic soft tissue defects of the lower third of leg, ankle and foot. Follow up for 6 months postoperative. Results: Twenty Patients; twelve males and eight females underwent reconstruction of different soft tissue defects over the foot and ankle using RSSAF. The overall complications occurred in 6 flaps; 4 minor and 2 major complications. The remaining 14 flaps passed an uneventful follow up. Conclusions: The reverse superficial sural artery flap RSSAF can be used as a reliable alternative to free tissue transfer in reconstruction of defects over the lower third of leg, ankle, and foot. Venous congestion is the major threat to the flap but its incidence can be minimized by wide pedicle, less kink of the flap, and keep the venae comitants around the artery.

Share and Cite:

Mohamed, M. and Mobarak, B. (2018) Role of Reversed Sural Artery Flap in Reconstruction of Lower Third of the Leg, Ankle and Foot Defects. Modern Plastic Surgery, 8, 50-59. doi: 10.4236/mps.2018.83007.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Ong, Y.S. and Levin, L.S. (2010) Lower Limb Salvage in Trauma. Plastic and Reconstructive Surgery, 125, 582-588.
https://doi.org/10.1097/PRS.0b013e3181c82ed1
[2] Heller, L. and Levin, L.S. (2001) Lower Extremity Microsurgical Reconstruction. Plastic and Reconstructive Surgery, 108, 1029-1041.
https://doi.org/10.1097/00006534-200109150-00036
[3] Zenn, M.R. and Levin, L.S. (2000) Microvascular Reconstruction of the Lower Extremity. Seminars in Surgical Oncology, 19, 272-281.
https://doi.org/10.1002/1098-2388(200010/11)19:3<272::AID-SSU9>3.0.CO;2-F
[4] Donski, P.K. and Fogdestam, I. (1983) Distally Based Fasciocutaneous Flap from the Sural Region. A Preliminary Report. Scandinavian Journal of Plastic and Reconstructive Surgery, 17, 191-169.
https://doi.org/10.3109/02844318309013118
[5] Masquelet, A.C., Romana, M.C. and Wolf, G. (1992) Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial Nerves: Anatomic Study and Clinical Experience in the Leg. Plastic and Reconstructive Surgery, 89, 1115-1121.
https://doi.org/10.1097/00006534-199206000-00018
[6] Jolly, G.P. and Zgonis, T. (2004) Soft Tissue Reconstruction of the Foot with a reverse Flow Sural Artery Neurofasciocutaneous Flap. Ostomy Wound Management, 50, 44-49.
[7] Imanishi, N., Nakajima, H., Fukuzumi, S., et al. (1999) Venous Drainage of the Distally Based Lesser Saphenous-Sural Veno-Neuroadipofascial Pedicled Fasciocutaneous Flap: A Radiographic Perfusion Study. Plastic and Reconstructive Surgery, 103, 494-498.
https://doi.org/10.1097/00006534-199902000-00020
[8] Francesco, G., Kolker, D. and Michael, H.R. (2007) Modified Reverse Sural Artery Flap with Improved Venous Outflow in Lower-Leg Reconstruction. Annals of Plastic Surgery, 59, 563-565.
https://doi.org/10.1097/01.sap.0000258452.55695.aa
[9] Hollier, L., Sharma, S., Babigumira, E., et al. (2002) Versatility of the Sural Fasciocutaneous Flap in the Coverage of Lower Extremity Wounds. Plastic and Reconstructive Surgery, 110, 1673-1679.
https://doi.org/10.1097/00006534-200212000-00008
[10] Foran, M.P., Schreiber, J., Christy, M.R., et al. (2008) The Modified Reverse Sural Artery Flap Lower Extremity Reconstruction. The Journal of Trauma: Injury, Infection, and Critical Care, 64, 139-143.
https://doi.org/10.1097/01.ta.0000240981.24052.e9
[11] Eren, S., Ghofrani, A. and Reifenrath, M. (2001) The Distally Pedicled Peroneus Brevis Muscle Flap: A New Flap for the Lower Leg. Plastic and Reconstructive Surgery, 107, 1443-1448.
https://doi.org/10.1097/00006534-200105000-00020
[12] Pai, C.H., Lin, G.T., Lin, S.Y., et al. (2000) Extensor Digitorum Brevis Rotational Muscle Flap for Lower Leg and Ankle Coverage. The Journal of Trauma, 49, 1012-1016.
https://doi.org/10.1097/00005373-200012000-00006
[13] Barclay, T.L., Sharpe, D.T. and Chisholm, E.M. (1983) Cross-Leg Fasciocutaneous Flaps. Plastic and Reconstructive Surgery, 72, 843-847.
https://doi.org/10.1097/00006534-198312000-00021
[14] Touam, C., Rostoucher, P., Bhatia, A., et al. (2001) Comparative Study of Two Series of Distally Based Fasciocutaneous Flaps for Coverage of the Lower One-Fourth of the Leg, the Ankle, and the Foot. Plastic and Reconstructive Surgery, 107, 383-392.
https://doi.org/10.1097/00006534-200102000-00013
[15] Saint-Cyr, M., Wong, C., Buchel, E.W., et al. (2012) Free Tissue Transfers and Replantation. Plastic and Reconstructive Surgery, 130, 858e-878e.
https://doi.org/10.1097/PRS.0b013e31826da2b7
[16] Morgan, K., Brantigan, C.O., Field, C.J. and Paden, M. (2006) Reverse Sural Artery Flap for the Reconstruction of Chronic Lower Extremity Wounds in High-Risk Patients. The Journal of Foot and Ankle Surgery, 45, 417-423.
https://doi.org/10.1053/j.jfas.2006.09.016
[17] Cheema, T.A., Saleh, E.S. and De Carvalho, A.F. (2007) The Distally Based Sural Artery Flap for Ankle and Foot Coverage. The Journal of Foot and Ankle Surgery, 46, 40-47.
[18] Follmar, K.E., Baccarani, A., Baumeister, S.P., et al. (2007) The Distally Based Sural Flap. Plastic and Reconstructive Surgery, 119, 138e-148e.
https://doi.org/10.1097/01.prs.0000259203.79909.7e
[19] Sugg, K.B., Schaub, T.A., Concannon, M.J., Cederna, P.S. and Brown, D.L. (2015) The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction. Plastic and Reconstructive Surgery. Global Open, 3, e519.

  
comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.