Superdrainage Reverse-Flow Sural Flap for Distal Leg and Foot Reconstruction: A Method to Overcome Venous Congestion in Diabetic Patients

Abstract

Background: Soft tissue defect reconstruction in foot andankle represents a significant challenge for the reconstructivesurgeons. The distally based sural flap provides a good optionfor coverage. Its main disadvantage is the reverse venousflow with frequent venous congestion. Many efforts made toovercome this problem such as super draining the vein throughsupercharging it to any superficial vein or intermittent drainageby venous cannulation.Patients and Methods: A comparative study was performedon diabetic patients with defects on the foot and ankle atPlastic Surgery Department, Qena University Hospital, fromMay 2017 to April 2019. Twenty patients were divided intotwo groups; Group (A): Defects had reconstructed with superdrainage reversed sural flap technique (10 cases) and Group(B): Defects had reconstructed with standard reversed suralflap technique (10 cases). They were 14 (70%) males and 6(30%) females. Ages of them ranged from 25-65 years old(mean 45 years). Different sites of defect sites had encounteredin the study: Heel in 15 cases (75%), ankle in 3 cases (15%)and distal leg in 2 cases (10%).Statistical analysis: Data was analyzed using the StatisticalPackage for Social Sciences (SPSS) version 20. A p-value<0.005 was considered significant.Results:• In Group (A) patients: At the second day post-operative,two cases (20%) had slight venous congestion which notrelieved by local injection of subcutaneous heparin. A partialflap necrosis occurred only in one of them and the otherhad complete flap necrosis and flap loss (another flapreconstruction was done). This case also showed wounddehiscence, and graft loss at the pedicle and the donor siteareas. All other flaps showed complete healing withoutcomplications.• In Group (B) patient: Venous congestion occurred in sevencases (70%) which ended in partial flap necrosis in fourcases (40%) and complete flap necrosis in three cases (30%).Also, wound dehiscence was reported in the three caseswith complete flap loss that underwent secondary surgeryfor re-stitching. Skin regrafting was performed in 2 (20%)cases at the pedicle and the donor site area.137The flaps usually healed eventually by 3rd week, but fullweight bearing on them postponed up to 6th week and allpatients were satisfied with the good functional and aestheticoutcomes.Conclusion: The distally based the sural flap is a versatileflap for the reconstruction of soft tissue defects of the lowerleg and heel. Despite its big problem concerning the reversevenous flow, superdrainage of the lesser saphenous vein eitherby supercharging or catheterization, provides an effectivesolution to keep away from venous congestion.