Abstract
Aim: Small soft tissue defects of the distal tibia and hindfoot resulting from traumatic, operative, or neoplastic conditions and chronic ulcers can be successfully dealt with the use of the reverse sural artery flap (RSAF). This study aims to describe a single center’s results and familiarity with this technique over a 15-year period of time.Material and methods: We retrospectively reviewed the clinical files of patients who were consecutively treated with RSAF and regularly followed up between January 1, 2004 and December 31, 2018, with a minimum postoperative follow-up period of two years. Patient demographics and comorbidities, location of the defect, performing surgeon, mean operation time, flap pedicle width, mean size of the defect, days of hospitalization following the operation, healing flap rate, and complications were recorded.Results: The sample consisted of 30 adult patients (25 men, 5 women), with a mean age of 51.07 years (16-80 years, SD 18.61). The mean operation time was 99.03 min (range 83-131, SD 10.57), and the mean size of the defect was 11.11 cm2 (range 6.1-19.4, SD 3.22). Successful flap rate (complete healing and coverage of the defect, with or without additional minor intervention) was 83.3% (25/30). Among successfully healed flaps, six patients with partial necrosis of the dermis were treated by an additional split-thickness skin graft. Five flaps failed to heal. Deep infection was present in two patients, leading to flap failure and reoperation. Serious venous congestion resulting in flap ischemia occurred in three cases. Circumferential keloid formation (not affecting successful outcome) was present in seven cases. Flap thickness approximated to normal within six months. All donor sites healed well (either by a split-thickness cutaneous flap or by immediate wound closure). Light paresthesia on the lateral border of the leg and foot disappeared within six months.Conclusions: A single-center experience with the RSAF has yielded satisfactory clinical outcomes, and the long-term tackle with the difficult reconstruction conditions around the ankle, has led to valuable advice on surgical technique and postoperative protocol, based on an anatomical basis.
Highlights
The distal third of the leg is an anatomic region where the use of fasciocutaneous flaps is often imposed by the need for soft tissue defects’ coverage
A single-center experience with the Reverse sural artery flap (RSAF) has yielded satisfactory clinical outcomes, and the long-term tackle with the difficult reconstruction conditions around the ankle, has led to valuable advice on surgical technique and postoperative protocol, based on an anatomical basis
Reverse sural artery flap (RSAF) is among various flaps proposed for the reconstruction of the distal leg, ankle, and foot defects, such as the lateral supra malleolar flap, peroneus brevis and extensor digitorum brevis muscle flaps, and crossed leg flaps
Summary
The distal third of the leg is an anatomic region where the use of fasciocutaneous flaps is often imposed by the need for soft tissue defects’ coverage. Restricted availability of skin for primary closure after injuries, operative interventions, and complications as well as chronic ulcers, require flap coverage of numerous tendons, vessels, and exposed bone. RSAF is a reliable, pedicled, local fasciocutaneous flap from the sural angiosome, suitable for heel and hindfoot defects, contained in the area of the posterior calf between the popliteal fossa and midportion of the leg [1]. It is centered over the middle raphe between the medial and lateral heads of the gastrocnemius muscle and can be raised as fasciocutaneous, adipofascial, and myocutaneous. It has a wide arc of rotation, which allows for coverage from the lower half of the leg up to the metatarsophalangeal joints on the dorsal aspect and base of the metatarsal bones on the plantar aspect of
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