DISTALLY BASED SURAL FASCIOCUTANEOUS FLAP FOR SOFT TISSUE RECONSTRUCTION OF THE DISTAL LEG, ANKLE AND FOOT DEFECTS

Authors

  • Samira Ajmal
  • Muhammad Ayub Khan
  • Riaz Ahmed Khan
  • Muhammad Shadman
  • Kanwal Yousof
  • Tariq Iqbal

Abstract

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. A
durable flap is the preferred option for coverage of such defects. This descriptive study was conducted
at Hayatabad Medical Complex and Said Anwar Medical Centre Peshawar over a period of 4 years to
evaluate the efficacy of distally based Sural flap in coverage of the lower third of leg, ankle and foot
defects, in 25 patients. Methods: A descriptive study was conducted at the department of Plastic and
Reconstructive Surgery at Hayatabad Medical Complex and Said Anwar Medical centre Peshawar. 25
patients with soft tissue defects over the distal leg and foot were included in this study. Distally based
sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the
defect and donor site morbidity studied. Results: Out of 25 flaps, 20 showed complete survival (80%).
Partial flap loss was found in 2 patients (8%), marginal flap necrosis in 2 patients (8%) and complete
loss in 1 patient (4%). Conclusions: The distally based sural flap is a versatile and reliable flap for the
coverage of soft tissue defects of the distal lower extremity. The procedure is done as a single stage; the
dissection is easy with short operating time and minimal morbidity.
Key Words: Distally based Sural flap; distal leg, heel and foot defects; reconstruction of foot

References

Fraccalvieri M, Boqetti P, Verna G, Carlucci S, Favi R, Bruschi

S. Ditally based fasiocutaneous sural flap for foot reconstruction:

a retrospective review of 10 years experience. Foot Ankle Int

;29:191-8.

Akhtar S, Hameed A. Versatility of the sural fasiocutaneous flap

in the coverage of lower third leg and hind foot defects. J Plast

Reconstr Aesthet Surg 2006;59:839-45.

Xu G, Jin LL. The coverage of skin defects over the foot and

ankle using the distally based sural neurocutaneous flaps:

Experience of 21 cases. J Plast Reconstr Aesthet Surg

;61:575-7.

Ahmed SK, Fung BK, Ip WY, Fok M, Chow SP. The versatile

reverse flow sural artery neurocutaneous flap: A case series and

review of literature. J Orthop Surg Res 2008;3(1):15-20.

Chen SL, Chen TM, Wang HJ. The distally based sural

fasciomusculocutaneous flap for foot reconstruction. J Plast

Reconstr Aesthet Surg 2006;59:846-55.

Pirwani MA, Samo S, Soomro YH. Distally based sural artery

flap: A workhorse to cover the soft tissue defects of lower 1/3

tibia and foot. Pak J Med Sci 2007;23:103-10.

Raveendran SS, Perera D, Happuharachchi T, Yoganathan V.

Superficial sural artery flap-a study in 40 cases. J Plast Reconstr

Aesthet 2004;57:266-9.

Hsieh CH, Liang CC, Kueh NS, Tsai HH, Jeng SF. Distally

based sural island flap for the reconstruction of a large soft tissue

defect in an open tibial fracture with occluded anterior and

posterior tibial arteries-a case report. Br J Plast Surg

;58:112-5.

Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied

by the vascular axis of the sensitive superficial nerves: anatomic

study and clinical experience in the leg. Plast Reconstr Surg

;89:1115-21.

Hasegawa M, Torji S, Katoh I, Esaki S. The distally based

superficial sural artery flap. Plast. Reconstr. Surg 1994;93:1012-6.

Hallock GG. Lower extremity muscle perforators flap for lower

extremity reconstruction. Plast reconst Surg 2004;114:1123-30.

Chen SL, Chen TM, Chou TD, Chang SC, Wang HJ. Distally

based sural fasciocutaneous flap for chronic osteomyelitis in

diabetic patients. Ann Plast Surg 2005;54(1):44-8.

Mozafari N, Moosavizadeh SM, Rasti M. The distally based

neurocutaneous sural flap: a good choice for reconstruction of

soft tissue defects of lower leg, foot and ankle due to fourth

degree burn injury.Burns 2008;34(3):406-11.

Cavadas PC, Bonanand E. Reverse-flow sural island flap in the

varicose leg. Plast Reconstr Surg 1996;98:901-2.

Koladi J, Gang RK, Hamza AA et al. Versatility of the distally

based superficial sural flap for reconstruction of lower leg and

foot in children. J Pediatr Orthop 2003;23:194-8.

Follmar KE, Baccarani A, Steffen P, Baumeister L, Levin S,

Erdmann D. The distally based sural flap. Plast Reconstr Surg

;119:138-48.

Baumeister SP, Spierer R, Erdmann D et al. A realistic

complication analysis of 70 sural artery flaps in a multimorbid

patient group. Plast Reconstr Surg 2003;112:129-40.

Chen SL, Chen TM, Wang HJ. The distally based sural

fasciomusculocutaneous flap for foot reconstruction. J Plast

Reconstr Aesthet Surg 2006;59:846-55.

Foran MP, Schreiber J, Christy MR, Goldberg NH, Silverman

RP. The modified reverse sural artery flap for lower extremity

reconstruction. J Trauma 2008;64:139-43.

Tosun ZO¨, zkan A, Karacor Z, Savaci N. Delaying the reverse

sural flap provides predictable results for complicated wounds in

diabetic foot. Ann Plast Surg 2005;55:169-73.

Ulrich MD, Bach, Alexander D, Polykandriotis E, Juergen K,

Horch RE. Delayed Flap for Staged Reconstruction of the Foot

and Lower Leg. Plast Reconstr Surg 2005;116:1910-7.

Al-Qattan MM. The reverse sural artery fasciomusculocutaneous

flap for small lower-limb defects: the use of the gastrocnemius

muscle cuff as a plug for small bony defects following

debridement of infected/necrotic bone. Ann Plast Surg

;59:307-10.

Al-Qattan MM. The reverse sural fasciomusculocutaneous

"mega-high" flap: a study of 20 consecutive flaps for lower-limb

reconstruction. Ann Plast Surg 2007;58:513-6.

Maffi TR., Knoetgen J, TurnerNS, Moran SL. Enhancing

survival using the distally based sural artery interpolation flap.

Ann Plast Surg 2005;54:302-5.

Tan O, Atik B, Bekerecioglu M. Supercharged reverse-flow sural

flap: a new modification increasing the reliability of the flap.

Microsurgery 2005;25:36-43.

Downloads

Published

2009-12-01

How to Cite

Ajmal, S., Khan, M. A., Khan, R. A., Shadman, M., Yousof, K., & Iqbal, T. (2009). DISTALLY BASED SURAL FASCIOCUTANEOUS FLAP FOR SOFT TISSUE RECONSTRUCTION OF THE DISTAL LEG, ANKLE AND FOOT DEFECTS. Journal of Ayub Medical College Abbottabad, 21(4), 19–23. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/3125

Issue

Vol. 21 No. 4 (2009): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.