Arch Hand Microsurg.  2017 Dec;22(4):280-287. 10.12790/ahm.2017.22.4.280.

Versatility of Delayed Reverse Sural Flap for Reconstruction of the Distal Lower Extremity in High-Risk Patients

• Park JK
• Kim KS
• Kim SH
• Choi J
• Yang JY

• KMID: 2406133
• DOI: http://doi.org/10.12790/ahm.2017.22.4.280

Abstract

PURPOSE
Soft tissue defects in the distal lower extremity represent a special challenge for reconstructive surgeons. Various methods of lower-limb wound coverage have been described, such as local flaps, distant flaps, and free flaps. Among various methods, the delayed reverse sural flap can be one of the several options for the reconstruction of distal lower extremity in high-risk patients. We report our experiences with the versatile, delayed reverse sural flap for coverage of the distal lower extremity in high-risk patients.
METHODS
From September 2015 to October 2016, seven patients with soft tissue defects of the distal lower extremity were treated with the delayed reverse sural flap based on a two-step procedure. All patients had significant medical comorbidities, such as diabetes mellitus, peripheral arterial disease, and smoking. The delay period ranged from 10 to 14 days, and the flap size was from 7.5×2.0 to 14.5×4.0 cm.
RESULTS
Six flaps survived without complications. One flap showed partial necrosis due to venous congestion but eventually survived.
CONCLUSION
Because the delay procedure improves flap viability, the delayed reverse sural flap may be a reliable and efficient alternative for reconstructing soft tissue defects of the distal lower extremity in high-risk patients.

Keyword

Sural; Lower extremity; Risk

MeSH Terms

Comorbidity
Diabetes Mellitus
Free Tissue Flaps
Humans
Hyperemia
Lower Extremity*
Necrosis
Peripheral Arterial Disease
Smoke
Smoking
Surgeons
Wounds and Injuries
Smoke

Figure

• 

  Fig.1. A case of posterior ankle defect. (A) Defect with exposure of the Achilles tendon. (B) Appearance at 1 week after 2nd stage of operation. (C) Appearance at 6 months postoperatively.

• 

  Fig.2. A case of heel defect. (A) Defect with exposure of the calcaneus. (B) Intraoperative photograph; the lesser saphenous vein (black arrow) and the sural nerve (white arrow) were identified in the pedicle. (C) Appearance immediately after 2nd stage of operation. (D) Appearance at 2 days after 2nd stage of operation. Venous congestion was seen. (E) Appearance at 15 months postoperatively.

• 

  Fig.3. A case of lateral malleolar defect. (A) Defect with exposure of the lateral malleolus. (B) Appearance immediately after 2nd stage of operation. (C) Appearance at 2 months postoperatively.

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