The Versatility of Distally Based Sural Flap for Reconstruction of Lower Leg and Foot

Abstract

The coverage of the soft-tissue on the lower third of the leg has always been a difficult problem to tackle. Distally based sural flap with a long pedicle can meet the patient's aesthetic and functional needs of reconstruction. We had used this flap on twenty-seven patients. Of these, twenty were males and seven were females. The flap reconstruction was used in such situations as chronic ulcer, trauma, open fracture, burn, hemangioma, and melanoma. There were six cases of defect located in the anterior tibia, six in Achilles tendon, six in heel, four in medial malleolus, two in lateral malleolus, and three in foot. The pedicle was passed through a tunnel to the defect in eighteen cases and skin graft was used in seven cases. Two patients received tubular flap coverage and division of pedicle two weeks later. The size of the flap was varied from 3×5 to 6×12 cm. There were twenty cases in the donor site with primary closure. Seven cases had skin graft. There were three cases that resulted in total failure and two cases that resulted in partial necrosis in the flap. Most of these complications had occurred in the diabetic patients. Regular blood sugar control and delicate harvest of the flap were requested. This series had demonstrated that a distally based sural flap provided a reliable and easy practical modality, as well as versatility and low donor-site morbidity, for reconstruction of small to medium defects of the lower limb.