Our round Japanese fan-like flap decreases complications: case reports of distally based sural flap

Abstract

Introduction: We report a modified distally based sural flap in the shape of a pedicle, based on deep fascia, which we call a “round Japanese folding fan-like flap,” that decreases the complication rate because our modified flap promotes reverse venous return through existing adipofascial tissue. Presentation of cases: A retrospective chart review was conducted on patients that underwent distally based sural flap reconstruction between 1994 and 2018 in Saga University Hospital and other related hospitals. We treated 25 patients (17 men and 8 women) who suffered from different etiological causes, for example, malignant tumors, trauma, osteomyelitis of the heel, and/or a diabetic foot. The mean flap size was 12.0 cm×7.0 cm (range: 7–20 cm×3–13 cm). All flaps survived, although 1 flap from among the 5 patients treated with standard distally based sural flap reconstruction before 2000 suffered from partial necrosis due to venous congestion. None of the 20 patients treated with the round Japanese fan-like flap have developed either partial or complete flap necrosis due to venous congestion. No other complications concerning the flap or donor site were observed. Discussion: The elevation of distally based sural flap is quick and easy to locate, however, it has been associated with complications, for example, postoperative venous congestion. Conclusion: The round Japanese fan-like flap (shaped from the pedicle to the distal area of the flap) promotes reverse venous return through existing adipofascial tissue, thus preventing the development of flap necrosis. This flap is able to cover a large wound defect of the ankle bone and cover the tendon with deep fascia by using a wrapping technique to treat the exposed tendon. Furthermore, our flap can be applied to many patients with large wound defects and/or diabetic foot patients.