Der modifizierte erweiterte distal gestielte sapheno-fasziokutane Suralislappen: Klinische Ergebnisse

Abstract

Summary An anatomical study was performed to develop a modified technique for an extended saphenofasciocutaneous sural flap for coverage of large combined soft tissue lesions at the lower leg and foot. Then a prospective clinical study was performed to investigate the clinical applicability of the new technique. From August 1999 to August 2002, 7 patients with 10 large combined soft tissue lesions with exposed tendon, bone and joint or compound infected wounds, with loss of bone and osteitis, were prospectively examined after an operative treatment using the extended saphenofasciocutaneous sural flap. All patients had a variety of additional risk factors or severe co-morbidity (traumatic ipsilateral vascular lesion of the major nutrient artery of the lower leg, ipsilateral deep vein thrombosis, diabetic polyneuro-pathy with arteriosclerotic vessels and severe occlusive vascular disease). The size of defect of the ten combined soft tissue lesions ranged from 80 to 180 cm2. The defects were located in the mid and hind foot and also the lower leg. A complete coverage of all defects was achieved in a single-stage procedure with a distally based modified saphenofasciocutaneous sural flap from the proximal lower leg. All flaps survived completely withhot any partial necrosis of the flap. The flap donor site was directly closed in 7 cases and a simultaneous skin graft was applied in 3 cases. All patients were repeatedly clinical examined and the mean duration of followup was 22 months. All flaps had complete success. Any secondary donor site morbidity was not registered. We did not observe formations of neuromas of the sural nerve. There was no need for secondary de-bulking. Venous congestion nor long lasting edema were not seen. All patients were satisfied with the functional and aesthetic results. The new flap provides many advantages. The flap is reliable for covering large defects even in a selection of patients with sub-stancial risk factors by preservation of the major arteries of the lower leg. The technique represents safe surgery, which can be performed at a single stage without microsurgery with an easy and quick dissection and with minimal morbidity of donor site.