Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects.

BACKGROUND: Reconstruction of soft tissue defects of the lower third of the leg, the heel and the hind foot remains a challenge. The distally based sural artery fasciocutaneous flap has been used effectively to resurface these defects. In many instances, it has obviated the need for free tissue transfer.

OBJECTIVE: The objective of the study is to evaluate the efficacy of reverse sural artery fasciocutaneous flap for coverage of lower third leg, posterior heel, malleoli and hind foot.

STUDY DESIGN: This is a descriptive study, which was conducted on 84 patients who presented with soft tissue defects in the area of lower third leg, heel, malleoli and hind foot.

PLACE AND DURATION OF STUDY: The study was conducted at department of plastic and reconstructive surgery, Federal Postgraduate Medical Institute Shaikh Zayed Hospital Lahore, over a period of 7 years from February 1997 to February 2005.

PATIENTS AND METHODS: Over a period of 7 years, a total of 84 patients with Soft tissue defect of lower third leg, heel, malleoli and hind foot were included. Preoperative data, the age and sex of each patient, cause and site of defect, dimension of flap, transposition of pedicle (through a tunnel or laid open and covered with a skin graft), postoperative results and complications were recorded. All patients were followed up in out patients department for 6 months.

RESULTS: Out of 84 patients, 54 were males and 30 females. Their ages ranged from 8 to 55 years with a mean of 31 years. Road traffic accidents was the cause of the defects in 53 patients, wheel spoke injury in 12 patients, trophic ulcer in five patients, osteomyelitis in five patients, marjolin ulcer in seven patients and diabetic ulcer in two patients. The site of 84 defects comprised 52 distal tibia; 20 tendo-Achillis and posterior heel defects; seven-malleolar region; three-anterior ankle and two-foot amputation stumps. The dimension of flap ranged from 5 to 15 cm in length and 4 to 12 cm in width. Postoperatively 66 flaps survived completely while marginal necrosis was seen in six patients and infection in four patients. The complete flap necrosis occurred in eight patients. There was no considerable morbidity at donor site and all patients had satisfactory functional outcome.

CONCLUSIONS: The distally based superficial sural artery flap is a versatile, reliable procedure, useful in reconstruction of lower third leg, heel, malleoli and hind foot defects. The surgical technique is safe, of short duration and provides alternative to microsurgical reconstruction.