Reverse sural rotational flap in the coverage of the lower leg after musculoskeletal oncologic resection

Abstract

The coverage of soft tissue defects in the lower extremity has proven to be challenging. The reverse sural flap provides reliable coverage with minimal complications. Six patients with sarcomas at the distal leg, ankle, and foot were treated with the reverse sural artery flap. Data was gathered for demographics, comorbidities, type of tumor, size of defect, flap viability, healing time, donor-site morbidity, recurrence, functional outcome, and range of motion. All patients possessed a primary sarcoma that traditionally would have required a free flap for coverage. The average size of defect was 94 cm2 (range 50–143) and was covered by flaps that ranged between 10 × 13 cm and 10 × 5 cm. Flap viability was 100 %, with healing occurring by 18 weeks (range 4–32 weeks). Donor-site morbidity was 0 %. Average revised MSTS score was 80 % or 24/40 (range 15–29). Average ROM for dorsi flexion was 0 ° and plantar flexion was 17.5 ° (range 10–25). Average time of follow-up was 8.75 months (range 4–14). In most patients without associated risk factors such as diabetes, the reverse sural flap can be performed safely. However, in patients with identifiable risk factors for partial flap failure, consideration should be given to alternative options such as free flap reconstruction in order not to delay or interrupt adjuvant radiotherapy. Level of Evidence: Level IV, therapeutic study.