Distally based sural fasciocutaneous flap for soft tissue reconstruction of the distal leg, ankle and foot defects

Abstract EN

Background : soft tissue management around the lower third of the leg and foot presents a Considerable challenge to the reconstructive plastic surgeon.

The options in this region are limited.

Durable flap is the preferred option for coverage of such defects. This study was conducted in AL sadder medical city in Alnajaf city over a period of 3 years to evaluate the efficacy of distally based Sural flap in the coverage of the lower third of leg, and foot defects, in 22 patients. Methods : A study was conducted in the department of Plastic and Reconstructive Surgery in AL sadder medical city in Alnajaf.

Twenty two patients with soft tissue defects over the distal leg and foot were included in this study.

Distally based sural fasciocutaneous flap was used for defect coverage in all patients.

In this study we did not extend the flap proximally on a random pattern, instead of this, we extend the flap only to that part of leg that coincide with the supra fascial course of sural nerve.

The limitation of flap size in such manner was restricted flap applicability for larger and more distal type, but we overcome this by using contra lateral reverse sural flap for covering a more distal defect that couldn’t covered by ipsilateral flap or when proximal calf tissue of ipsilateral limb was unsuitable for flap harvesting .

Ipsilateral reverse sural flaps were used in 15 cases, and 7 cases the flap used in contra lateral limb (cross leg flap). Results : from January 2008 to March 2011, 22 patients, their ages ranged between 5-42 years.

(Average age was 17 years), with soft tissue defect in the distal leg and foot, (45.5 % in distal leg), trauma was the cause in 68.2 %.

Reverse sural flap from ipsilateral limb have been used in 68.2 %, and from the contralateral limb in 31.8 %, complete flap survival in 100 % of cases with no major complication in the donor or recipient site apart of flap venous congestion in 9.1 % which resolve with few days.

Conclusions : The distally based sural flap is a versatile and reliable flap for the coverage of soft tissue defects of the distal third of the leg and foot.

It is safer to apply the flap from contra lateral limb rather than its extension proximally, if micro vascular surgical facilities are not available.