Arch Plast Surg.  2014 Nov;41(6):709-715. 10.5999/aps.2014.41.6.709.

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

• Mok WL
• Por YC
• Tan BK

• KMID: 2267622
• DOI: http://doi.org/10.5999/aps.2014.41.6.709

Abstract

BACKGROUND
The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot.
METHODS
The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve.
RESULTS
From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle.
CONCLUSIONS
The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

Keyword

Surgical flaps; Perforator flap; Sural nerve; Hypesthesia; Soft tissue injuries

MeSH Terms

Ankle
Arteries*
Cadaver
Extremities
Fascia
Foot
Humans
Hypesthesia
Leg
Lower Extremity
Perforator Flap
Range of Motion, Articular
Saphenous Vein
Sensation
Soft Tissue Injuries
Sural Nerve*
Surgical Flaps
Tissue Donors