Pdf increasing the success of reverse sural flap from proximal part. Consideration in using the lscn in sural flap sensory. The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among surgeons. A total of 71 patients were operated on with this technique, some of them with basic pathologic abnormalities limiting the distal blood flow, such as diabetes. Can sural fasciocutaneous flaps be effective in patients. Department of plastic and reconstructive surgery, international university of health and welfare hospital, tochigi, japan. The pivotal point of the pedicle was three fingers breadth proximal to the tip of the lateral malleolus. A line of incision was traced over the presumed course of the sural nerve and the lesser saphenous vein. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
With the introduction of perforator flap, management of small and mediumsize defects of distal leg and ankle region is convenient, less time. Almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. Questionspurposes 1 what is the likelihood of flap survival in a small series of patients older than 64 years who underwent reverse sural artery fasciocutaneous flap for coverage of lower extremity wounds. Soft tissue reconstruction of the foot using the distally. Figure 6 a a 22yearold male presented with a left foot degloving. Pdf the gastrocnemius muscle flap for coverage of soft. The distally based sural artery flap for ankle and foot coverage. The result after performing surgery flap was viable without any complication. Reconstruction of the foot and lower leg defects by. The technique is based on the use of a reverseflow island sural flap combined with other flaps in three cases crossleg, peroneal. International journal of science and research ijsr is published as a monthly journal with 12 issues per year. Soft tissue defects with or without exposed bones in the lower extremity, ankle and the footwith or without bone defects or exposed hardwareoften require coverage with vascularized flaps.
Its versatility, in which thickness and volume may be adjusted, leads to a perfect match for reconstruction of dorsal foot defects. The reverse sural fasciocutaneous flap for the treatment. The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. Comparison between peroneus brevis flap and reverse sural. Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. Sural nerve preservation in reverse sural artery fasciocutaneous flapa case report article pdf available in annals of surgical innovation and research 61. The reverse flow sural artery neurocutaneous flap is being rotaed through an arc 180 degrees on its pedicle.
Distally based perforator sural flaps for foot and ankle reconstruction. The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. Large soft tissue defects of ankle and foot always have been challenging to reconstruct. Notably, it is a referred, highly indexed, online international journal with high impact factor. Surgical anatomy of the medial sural artery perforator flap. Pdf in this report, we present our experience on the use of the reverse sural flap. Partial flap loss was found in 2 patients 8%, marginal flap necrosis in 2 patients 8% and complete loss in 1 patient 4%. Defects at this site will often require flap cover. The flap inset into the defect after rotation with excellent coverage. The versatile reverse flow sural artery neurocutaneous. The gastrocnemius muscle flap for coverage of soft tissue defect of the proximal third of lower leg. Distally based perforator sural flaps for foot and ankle. Rbcp reconstruction of soft parts lesions of the heel.
Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. Reverse sural fascio cutaneous flap for soft tissue. Reverse peroneal artery flap for large heel and sole defects. Sural flap can become the answered and alternative solution to closure defect in the calcaneal region. Surgical anatomy of the medial sural artery perforator flap wong et al. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. The coverage of the softtissue defects in distal lower leg, ankle, and foot has been a challenge to trauma, orthopedics, foot and ankle, and plastic surgery departments due to the limited availability of the soft tissue in this region. The lateral supramalleolar skin flap offers a range of coverage similar to that of the sural flap, but the dissection is more difficult than for a sural flap and offers no advantages, the remaining nonsensitive area in sural flaps is smaller than the one left after the.
Immediate reconstruction should always be considered after resection with a negative margin, and should be attempted whenever possible. Abstractthe defects left by resection of bone and softtissue sarcomas often require reconstructive surgery to provide adequate wound coverage, preserve limb function, and optimize cosmetic results. The sural fasciocutaneous flap has successfully been used to reconstruct tissue loss in these areas. We combined method the tumor excision for malignant melanoma and performed sural flap to closure the soft tissue defect after performing wide excision tumor. To study the distally based sural flap in patients with soft lesions in the lower third of the leg, ankle, heel and foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. B a reverse fasciocutaneous sural flap with inclusion of muscle cuff was used to. Reverseflow islanded sural flap can be used for reconstructiing a large area, e.
Sshaped reverse sural flap for reconstruction of tissue defect on. Distally based perforator sural flaps are perfused by a. The distally based island sural flap was outlined at the junction of the two heads of g the astrocnemius muscle. Versatility of delayed reverseflow islanded sural flap. Considerations surrounding reconstruction after resection. Harvest of distally based fasciocutaneous island flap from the lateral sural region with a wide adipofascial pedicle. The choice of reconstructive method and tissue flap depends. Flap decisions and options in soft tissue coverage of the. At this point, the island flap including the skin, subcutaneous tissue, and the deep fascial tissues containing the neurovascular structures. The distally based sural flap is safe, reliable and operatively quick to perform negating free flap reconstruction.
Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Pdf the distally based sural artery flap for ankle and. Full text the distally pedicled peroneus brevis muscle. Reverse sural artery flap christopher finkemeier, md on. Pdf sural nerve preservation in reverse sural artery. Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle. Experience with this technique and the additional cautions described herein may contribute to even better results. Free flaps, which add healthy tissue especially to the lower extremity instead of further injuring a limb, are the first choice in high volume microsurgical centres. In the results of our anatomical study submitted data, we found by angiography using cadavers that the small extrinsic vessels around the sural nerve and lesser saphenous vein were important structures, especially in the distally based sural flap, and that those located around the sural nerve were particularly important for flap survival. Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction. However, this flap may be limited by the size of the defect, reasonably covering an area up to 10cm square 59, 60. Video shows the technique for a reverse sural artery flap used to cover a full thickness skin loss over the calcaneal tuberosity from delay in treatment of a severely. Malignant soft tissue tumor, wide excision, and sural flap. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap.
Evaluation of the reverse sural artery flap in the. Free flap is ideal for these defects and gives good results but with its own limitations. The distally based superficial sural artery flap, first described as a distally based neuro skin flap by masquelet et al. It is a versatile and reliable technique for softtissue reconstruction of the heel and ankle. Though numerous surgical reconstructive options have been reported, the instep flap represents an ideal option and seems to be more acceptable to patients than others. An alternative in sensory reconstruction of the foot and ankle defects article pdf available in microsurgery 353 september 2014 with 1 reads how we measure reads. The anterior lesions were rebuilt preferentially using the plantar medial flap based on the plantar medial artery and the posterior lesions was used the reverse sural flap preferentially. Large superficial veins should be interrupted and ligated distal to the pivot point of the flap to prevent flap congestion and swelling. Sural flap use for the treatment of wounds with underlying.
Sshaped reverse sural flap is a modified technique of reconstruction. Large superficial veins should be interrupted and ligated distal to the pivot point. Clougherty, dpm reverse sural flap matthew endara, md medial plantar artery flap matthew endara, md fasciocutaneus flaps matthew endara, md case presentations faculty lunch. Pdf distally based perforator sural flaps for foot and. Checklist of responsibilities for the scientific editor of this article publishing process of this article. The reverse sural fasciocutaneous flap for the treatment of traumatic. In this report of 6 patients underwent surgical reconstruction by this.
The versatility of perforatorbased propeller flap for. The distally based sural flap is an option in the reconstruction of these areas because of the largest arc of rotation and does not sacrifice any major artery. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. In a total of eleven cases, eight were submitted to reconstruction with reverse sural flap and four with plantar medial flap. Reconstruction of weightbearing heel defects remains a challenge because of the unique characteristics of the plantar skin. The distally based sural artery flap for reconstruction of. Pdf increasing the success of reverse sural flap from. The sural fasciocutaneous flap is a good option in reconstruction of difficult and complex wound in lower leg and foot especially on ankle joint, malleoli. Thoracodorsal artery perforator flap rnal of clinical and analytical medicine 21. Read the latest articles of the journal of hand surgery. The use of distally pedicled peroneus brevis muscle and fasciocutaneous sural artery flap for coverage of the distal end of lower leg is recommended for soft tissue defects with exposure of bones andor tendons in patients who are not willing or healthy enough to undergo free microvascular tissue transplantation, and do not require microsurgical expertise. However, when the heel defect expands to the instep area, the ipsilateral instep is not available for.