Modified Distally Based Sural Nerve Flaps in Acute Traumatic Forefeet Reconstructions

Abstract

Conventional reversed sural flaps have been used to cover lower one-third of the leg defects. However, the experience of the authors indicates that when the soft-tissue defect located at the dorsum of the metatarsophalangeal joint, distal marginal necrosis of the flaps usually occurs, which is the exact part of the flap that one needs the most. Finding a new method to augment the blood supply of the flap can be a difficult task. The authors found there is a constant cutaneous branch emanate from the peroneal artery at the point 11.0 +/- 1.7-cm upon the lateral malleolus. Ten modified distally based reverse sural artery flaps, in which the cutaneous branches from the peroneal artery 11.0 +/- 1.7-cm upon the lateral malleolus were added, were performed for the distal-third of the foot reconstruction between 2003 and 2006. All of the flaps survived completely after the operation. Distal marginal necrosis did not occur in any of the flaps. When conventional local flaps are inadequate, this flap should be considered for its reliability and low associated morbidity.