Sural flaps

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Tibial osteomyelitis, in association with bone loss and a soft tissue defect, poses a significant reconstructive challenge, especially in high-risk patients. We describe a case of methicillin-resistant Staphylococcus aureus tibial osteomyelitis with intercalary bone loss successfully managed with bifocal Ilizarov compression osteogenesis at the bone resection site and proximal distraction osteogenesis, accompanied by a reverse sural fasciocutaneous flap performed with a delayed technique. When free tissue transfer is not a reconstructive option owing to medical comorbidities or patient refusal, the reverse sural flap combined with bifocal Ilizarov compression and distraction osteogenesis can provide a reconstructive option to achieve limb salvage for these challenging cases...

Coverage of soft-tissue defects of the leg has improved with the discovery of new flaps. However, surgeons now have to deal with new lesions on top of previous reconstructive surgeries. We present a case of soft-tissue defect of the anterior lower third of the leg presenting 20 years after reconstructive surgery for an open fracture and its management. The anterior tibial and fibular arteries were occluded with a retrograde vascularisation of the fibular artery; this provided a perforator artery that we used as a pivot point for an atypical sural island flap with a good result at 6 months...

The delay reverse sural neurofasciocutaneous flap is used to reconstruct soft tissue defects in the lower third of the leg to improve outcome in patients with associated comorbidities such as diabetes mellitus, hypertension, hypercholesterolaemia, smokers and ischaemic heart disease. The author reports the use of a delayed reverse sural flap as soft tissue cover for a calcaneal defect in a patient with associated comorbidities who has an ipsilateral Gred 3C (Gustilo) tibial fracture after vascular reconstruction...

The distally based sural flap has become popular for reconstruction of the foot and leg. However, this flap often fails due to venous congestion. In this report, we developed a new modification of the distally based sural flap. The procedure comprised three stages. In the first stage, the flap was raised cephalad to the midpoint of the posterior aspect of the leg, involving reanastomosis of the short saphenous vein (SSV) at the proximal end of the flap. In the second stage, ligature of the SSV was performed...

The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap...

The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel...

In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. The patient selection and surgical refinement are discussed. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at the Chang Gung Memorial Hospital. The defects were located at the ankle (three cases), foot (two cases), and heel (six cases). Particular attention was paid to precise patient selection and surgical refinements. Patient selection was based on the lower limb vascular status by palpable distal pedal pulses and ankle brachial index ranging from 0...

BACKGROUND: Distally based perforator propeller sural flaps that pedicled on an isolated perforator from the peroneal artery or posterior tibial artery are a versatile local reconstructive option for defects of the foot and ankle region. However, flap venous congestion is yet a difficult problem after operation. We hypothesize that containing some adipofascial tissues around the axial perforator can preserve some tiny venous return routes, improve venous drainage, and ultimately enhance flap safety in distally based sural flaps...

BACKGROUND: The distally pedicled suralis flap is used to cover local defects of the distal lower leg, ankle and hind foot. It is a local flap with no need for microvascular anastomosis, a constant blood supply and ease of elevation. Disadvantages are lack of sensation, donor site morbidity and venous congestion. METHODS AND MATERIAL: This study includes 25 patients. Apart from the defect extent, cause and location, complications were also determined. RESULTS: The defect site was located in the hind foot in 5 cases and the distal lower leg in 14 cases...

BACKGROUND: Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. We aimed to compare functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs). METHODS: Between 2003 and 2006, 52 patients (24 DSFs and 28 PBFs) were included. For increased reliability, all extended sural flaps were delayed for 3-15 days. At the end of the follow-up period (minimum 12 months), patients were asked to fill out a modified foot and ankle score (Foot and Ankle Outcome Score (FAOS)) questionnaire...

The arterial insufficiency is not rare in high risky patients for the reverse sural flap. Thus, we introduce a novel practical technique by performing intraoperative patency test to the sural artery to predetermine the arterial potential, to avoid a possible arterial insufficiency and to increase the reliability of the sural flap in these patients. We successfully applied the reverse sural flap to seven risky patients with crushing injury, mine explosion, and diabetes, in whom the sural artery patency test was positive...

BACKGROUND: Soft-tissue defects of the foot and lower leg caused by traumatic injury, tumor ablation, or infection associated with osteomyelitis often require coverage by flaps. One excellent option for reconstruction of these defects is the distally based neurofasciocutaneous sural flap. It allows rapid and reliable coverage of defects from the distal third of the lower leg to the forefoot without significant functional donor-site morbidity. However, the maximal size of the flap is limited by the delicate perfusion of the arterial network associated with the superficial sensory nerve...

Defective wounds in diabetic foot are difficult to manage. Several studies reported the use of reverse sural flap in a small number of patients with varying success. We presented our experience with the reverse sural island flap (RSIF) in a series of 37 patients associated with diabetic foot using the delay procedure. The ages of the patients ranged between 36 and 73 years. We did not perform angiographic evaluation to determine the existence of vascular connections between the branches of the peroneal and posterior tibial artery; however, Doppler ultrasound evaluation was done to determine the patency of anterior and posterior tibial arteries, as well as lesser saphenous vein before the operation...

We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and in 3 cases as a fascial flap only. The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg...