DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20164787

Distally based reverse sural artery flap as an interpolation flap

Srijana Muppireddy, Srikanth R.

Abstract


Background: Coverage of soft tissue defects of the foot and ankle has imposed a challenging situation to the plastic surgeon. Some patients have contraindications for microsurgery, thus limiting the options for local tissue transfer. The Reverse sural artery flap is frequently used for reconstruction of distal third leg, ankle, and heel. The major disadvantage of RSA flap is compression of pedicle within subcutaneous tunnel leading to venous congestion and distal flap necrosis. To overcome this problem, we describe an interpolation flap technique in which subcutaneous tunneling of neurovascular structures is avoided.

Methods: 13 cases of distally based RSA flaps as interpolation flap were performed for soft tissue defects in dorsum of foot, heel pad, malleoli, and TA region during the period 2014 to 2016.

Results: With this procedure no flap loss was observed in this series and only a few minor complications occurred. The pedicle is divided in a second stage operation.

Conclusions: We conclude that transferring the flap in 2 stages without use of tunnel improves the reliability of flap and decreases the chances of necrosis.


Keywords


Reverse sural artery, Interpolation, Lower extremity reconstruction

Full Text:

PDF

References


Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: Experimental study and clinical applications. Br J Plast Surg. 1987;40:113.

Taylor GI, Ham FJ. The free vascularized nerve graft. Plast Reconstr Surg. 1976;57:413.

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. 1992;89(6):1115-21.

Mohamed ES, Osama Y. Increasing the success rate of the reversed-flow fasciocutaneous island sural flap: a clinical experience in 26 cases. Ann Plast Surg. 2006;57:653-7.

Yang D, Morris SF. Reversed sural island flap supplied by the lower septocutaneous perforator of the peroneal artery. Ann Plast Surg. 2002;49:375–8.

Almeida MF, da Costa PR, Okawa RY. Reverse-flow island sural flap. Plast Reconstr Surg. 2002;109:583–91.

Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg. 2006;59:839–45.

Mojallal A, Wong C, Shipkov C, Bailey S, Rohrich RJ, Saint-Cyr M, et al. Vascular supply of the distally based superficial sural artery flap: surgical safe zones based on component analysis using three-dimensional computed tomographic angiography. Plast Reconstr Surg. 2010;126:1240–52.

Jepegnanam TS, Nithyananth M, Boopalan PR, Cherian VM, Titus VT. Reconstruction of open contaminated achilles tendon injuries with soft tissue loss. J Trauma. 2009;66:774–9.

Ponte´n B. The fasciocutaneous flap: Its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34:215-20.

Morgan K, Brantigan CO, Field CJ, Paden M. Reverse sural artery flap for the reconstruction of chronic lower extremity wounds in high-risk patients. J Foot Ankle Surg. 2006;45:417–23.

Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg. 1984;37:80–7.

Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg. 2007;119:590-8.

Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg. 2011;64:386–93.

Loonen MP, Kon M, Schuurman AH, Bleys RL. Venous bypass drainage of the small saphenous vein in the neurovascular pedicle of the sural flap: anatomical study and clinical implications. Plast Reconstr Surg. 2007;120:1898–905.