Distally Based Saphenous Nerve-Greater Saphenous Venofasciocutaneous Flap for Reconstruction of Soft Tissue Defects in Distal Lower Leg.

Abstract

To this day, the reconstruction of soft tissue defects in the distal lower leg is still a challenge for reconstructive surgeons. At present, free flap, musculocutaneous flap, anterior and posterior tibial artery flap, cross-leg flap, and distally based neurocutaneous flap are the main surgical alternatives. However, these methods are not always satisfactory. This article describes our experience with the distally based saphenous nerve-greater saphenous venofasciocutaneous flap method to reconstruct soft tissue defects in the distal lower leg. A total of 27 patients (17 men and 10 women) underwent reconstructive surgery in our department from October 2009 to July 2012. Their mean age was 44.8 years (range, 16-62 years). The mean follow-up period was 18 months (range, 12-30 months). The only etiology was acute traumatic injury. Defects were located in the distal tibia around the ankle joint and the foot. The fasciocutaneous pedicle was 3 to 4 cm wide and the anatomical structures consisted of the superficial and deep fascia, the saphenous nerve, the greater saphenous vein, and their accompanying vessels together with an islet of subcutaneous cellular tissue and skin. The pivot point was approximately 5 cm proximal to the tip of medial malleolus. The size of skin islands ranged from 7 × 5 to 14 × 10 cm. All flaps survived without any partial necrosis and no arterial crisis occurred postoperatively in any case. Severe venous congestion occurred only in 1 case; however, the flap got better gradually and survived eventually after limb raise and interrupted bloodletting. All donor sites were 1-stage closed with split-skin grafting. The reverse saphenous neurocutaneous island flap is a reliable and efficient method to reconstruct soft tissue defects in the distal lower leg. Both this flap and the classic sural flap provide valuable alternative coverage of such defects.