Repair of skin defects at the leg, ankle and foot using retrograde sural neurovascular island flaps with blockade of small saphenous vein

Abstract

Objective To investigate the clinical effect of retrograde sural neurovascular island flaps with blockade of small saphenous vein in the repair of skin defects at the leg, ankle and foot. Methods The clinical data of 39 patients with skin and soft tissue defects (defect area 3.5 cm×3 cm-9.0 cm×7.2 cm) at the leg, ankle and foot caused by trauma or infection, who stayed in our hospital between January 2012 and December 2016, were retrospectively analyzed. According to the operation methods, the patients were divided into the control group (n=19) and ligation group (n=20) . The defects were repaired with retrograde sural neurovascular island flaps. The area of skin flaps in the control group and study group was 4 cm×3.5 cm-10 cm×6.5 cm and 5 cm×3 cm-10 cm×8 cm, respectively. The small saphenous vein was ligated and blocked at the proximal site of the flaps in the control group. In addition, the initiation of the small saphenous vein was dissected at behind the lateral malleolus and then further ligated in the ligation group. The incidences of swelling, cyanosis, and complete survival rate of the flaps were compared between the two groups. The flap texture, donor site healing, and ankle joint function at the last follow-up were evaluated. Results Flap necrosis was found in 5 cases. Thirty-four flaps survived completely and were followed up for 8-60 months with an average of (33.5±8.6) months. The incidence of flap swelling in the ligation group was lower than that in the control group (10% vs 47.37, P 0.05) . The texture of all surviving flaps, ankle joint function, and donor site healing and function in the two groups were good at the last follow-up. Conclusion Blocking small saphenous veins of retrograde sural neurovascular island flaps favors the repair of skin defects at the leg, ankle and foot. Key words: Flap; Sural nerve; Small saphenous vein; Foot and ankle; Leg