Clinical application of lower leg posterolateral perforator flap with preserved sural nerve

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Objective To explore the surgical techniques of preserving sural nerve and lesser saphenous vein while harvesting lower leg posterolateral flap based on distal perforator of the fibular artery, and evaluate the treatment results of repairing foot and ankle defects with the flap. Methods From May 2011 to September 2013, soft tissue defects around the foot and ankle in 12 patients were repaired by transferring fibular artery distal perforator flap. The sural nerve and lesser saphenous vein were left intact in the donor site, while the sural neurovascular network was included in the lower leg posterolateral flap. The defects were caused by trauma in 6 cases, by chronic diabetic ulceration in 4 cases, and by necrosis following infection in 2 cases. The size of the wounds ranged from 4.0 cm×2.5 cm to 8.0 cm×5.0 cm. Flaps size ranged from 9.0 cm×4.0 cm to 17.0 cm×7.0 cm. Skin grafts were applied to cover the donor sites. Postoperatively, blood supply of the flaps, swelling of the leg, and pain were closely monitored for 10 days. Flap appearance, contour, and sensation were evaluated later. Questionnaire survey of patient satisfaction of the flap and AOFAS scoring were performed 6 to 12 months postoperatively. Results Complete survival was seen in 10 flaps. Two flaps had partial marginal necrosis in the distal portion, which were managed with surgical debridement. The wound healed in two months. Nine patients had more than 12 months′ follow-up. The flaps had good appearance and good contours. Swelling of the leg was minimum. Pain, temperature and touch perception of flaps at 12 months postoperatively indicated S3 sensory recovery. Patients were satisfied with the appearance of the flaps. The AOFAS scores were 87 to 93, the mean score being 90.2. Conclusion Posterolateral lower leg flap pedicled on fibular artery distal perforator can be safely raised without severing the sural nerve and lesser saphenous vein, which minimizes donor site morbidity without compromising blood supply of the flap. Key words: Surgical flaps; Wounds and injuries; Sural nerve; Perforator