The Reverse Sural Fasciomusculocutaneous “Mega-High” Flap

Abstract

The reverse sural artery flap was initially described as a fasciocutaneous flap and has become an acceptable technique of lower-limb reconstruction. The flap was recently modified to include a midline gastrocnemius muscle cuff around the sural pedicle in the upper part of the leg, and hence improving its blood supply. Large lower-limb defects require "mega" flaps (including the whole width of the calf) harvested "high" all the way up to the popliteal fossa. The following study was designed to answer the following question: Is this "mega-high" reverse sural fasciomusculocutaneous flap reliable? A total of 20 consecutive male patients with large lower-limb defects who were reconstructed with this flap were included. The skin of the whole width of the upper calf (extending 2-3 cm below the popliteal fossa crease line) was harvested without delay in every case. Primary wound healing of the flap was noted in all patients confirming its reliability. Indications and technical hints to ensure successful reconstruction are discussed.