Reliable Flap Research Articles

Extensor digitorum brevis muscle flap for lower extremity coverage in a context of posttraumatic sepsis

IntroductionTraumatic injuries to the distal quarter of the leg present a significant risk of skin necrosis and exposure of the underlying fracture site or the osteosynthesis material that often result in bone and joint infection. In the case of small or medium-sized bone exposure, local muscles may be one of the best options for lower extremity coverage. We describe our experience using the extensor digitorum brevis muscle flap in a context of posttraumatic bone and joint infection in fourteen patients. Our main objective was to assess the outcomes and the donor-site morbidity of the extensor digitorum brevis muscle flap. Materials and methodsA single-center retrospective study in a French reference center for bone and joint infection from 2014 to 2018 reviewed cases of traumatic injuries with skin complications and bone and joint infection that required an extensor digitorum brevis muscle flap coverage. Fourteen patients were evaluated for early and late complications, 11 men and three women with a mean age of 51.4±17.72 (19–71) years. Seven of these were open fractures and nine cases were pilon fractures. Donor-site morbidity was assessed in nine patients. ResultsEarly flap complications included two cases (14.2%) of hematoma, one case (7.1%) of partial necrosis and four cases (28.5%) of donor-site dehiscence. Late complications caused by persistent infection were found in two patients (14.2%), with one case (7.1%) of chronic osteoarthritis and one case (7.1%) of septic pseudarthrosis. From a functional and cosmetic point of view, eight patients (89%) were satisfied, to very satisfied. ConclusionExperience and a multidisciplinary approach are keys in providing an optimal treatment strategy for complex cases of bone and joint infection. The extensor digitorum brevis muscle is a reliable flap for small defects with underlying infection. Being made up of muscle tissue, this flap offers good resistance to infection and enables satisfactory distribution of antibiotics. Level of evidenceIV.

Nuts and bolts of PMMC flap in oral cancer and its clinical outcome in 168 indian patients: A retrospective analysis

IntroductionThe gold standard for reconstruction is the microvascular free flaps, whereas pedicled flaps are generally employed as a rescue procedure. Pectoralis major myocutaneous flap (PMMC) flap being a reliable flap is associated with high rate of complication. So, the purpose of this study was to check and assess the predictability of PMMC Flap and its clinical outcome in 168 Indian patients. Materials and methodWe conducted a retrospective study of PMMC flap which was harvested in 168 Indian oral cancer patients in 3 years time span. Patients were kept on follow up for 1–3 years. Rate of complication were documented for flap necrosis and wound dehiscence; and patient related data like neck bulk acceptance and range of motion were recorded. Gender comparison of complications were also documented. ResultsThe most common complication was wound dehiscence in 11 (6.5%) patients. Partial flap necrosis was observed in 3 (1.8%) female patients. There was no case of total flap necrosis. Questionare method was used for patients to record neck bulk acceptance. Range of motion was evaluated during follow up period. Follow up period of all the patients was 1–3 years. ConclusionPMMC flap is still a well founded ‘workhorse’ flap for reconstruction in head and neck cancer patients and can be used successfully with acceptable morbidity.

Functional and aesthetic outcomes of pedicled temporalis muscle flap for mesostructure reconstruction

The purpose of this work is to analyse the soundness of the Temporalis Muscle Flap as a safe and reliable flap to restore the aesthetic and functions of the facial mesostructure after its partial resection.Subjects were selected retrospectively and were invited to come to our outpatient clinic. Here, subjects completed a clinical evaluation in which the medical examiners evaluated the aesthetic outcome, the phonation, the ocular motility and the swallowing.Twenty-two subjects were enrolled in this study and completed the clinical evaluation. The mean value of the score obtained for the aesthetic outcome was 2.91 ± 0.92, slightly less than good. The VHI-30 questionnaire for voice evaluation obtained a mean score of 22.5 ± 11.5, pointing out minor voice problems. The mean value of the P-score evaluated during Fiberoptic Endoscopic Evaluation of Swallowing was 4.64 ± 0.95, highlighting the near absence of endoscopic signs of dysphagia. On the evaluation of ocular function, only one subject showed an inferior displacement of his right eyeball without vertical diplopia.The Temporalis Muscle Flap is a safe and reliable flap that can be used to reconstruct numerous surgical defects of the maxilla, giving an excellent recovery of physical aspect, phonation, and swallowing.

New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction.

In the palatal defects due to surgical resection, flap selection is very important for a correct reconstruction. Different methods have been suggested over the time, however the pedicled buccal fat pad is a simple, effective, reliable flap for reconstruction after palate tumor resection. The aim of the present study is to introduce a new surgical technique for palate reconstruction with pedicled buccal fat pad flap exposing the advantages. The Authors performed this procedure in 17 patients in order to treat medium-sized oncologic surgical defect of palate region in the period between 2016 and 2019. Complete wound healing after only 4 weeks without complication after 12 months follow-up was observed. This is the first cases series described with this new technique.

Tongue flap for lip defects: Our experience.

Background: Background: Lip defects following neoplasm surgery are usually complicated. Appropriate reconstruction is vital in improving the quality of life of such patients. In this study, we have assessed the usefulness of the dorsal/lateral tongue flap in cases of lip reconstruction.
 Methodology: A retrospective data of patients who reconstructed with either dorsal or lateral tongue flap between November 2015 and June 2018 was collected. Departmental Ethical clearance was done.
 Results: A total of four patients who underwent tongue flap reconstruction during this period were analyzed. The size of the defect following excision of the lesion ranged from 3-5.5 cm. There was no partial or total loss of flap in our series. Postoperatively all the patients had adequate mouth opening, good swallowing.
 Conclusion: Dorsal or Lateral tongue flap is a simple and reliable flap for lip reconstruction. It helps in providing good functional results with less morbidity.

Use of Adipofascial Reverse Sural Artery Flap for Distal Leg and Ankle Region Reconstruction- A Prospective Cohort Study

Introduction: Though distally based sural artery fasciocutaneous flap is a good choice for distal leg and ankle reconstruction, shortcomings like venous congestion and flap bulkiness are matters of concern. Aim: To assess the utility of adipofascial flap for distal leg and ankle reconstruction, complications, and long-term functional results with range of motion at ankle joint. Materials and Methods: A prospective cohort study (January 2018 to December 2019) was conducted at Safdarjung Hospital, New Delhi, India on patients having distal leg defect and ankle defects reconstructed with Distally Based Sural Artery Adipofascial Flap (DBSAAF). Participants of any age and aetiology were included in the study while polytrauma patients, life-threatening injuries, mangled extremity patients were excluded. Postoperatively flap survival, complications and functional outcome were assessed. Results: Total 21 patients with above defects had undergone DBSAAF reconstruction. Fifteen (71.4%) patients were males and 6 (28.6%) were females, with mean age of 34.85 years. Causes of defect were road traffic injury in 6 (28.6%) patients, additional Tendoachilles tear was repaired in 5 (23.8%) patients. Four (19%) patients had avulsion injury, 3 (14.3%) patients had postburn unstable scar, and chronic ulcer was found in 3 (14.3%) patients. The maximum defect size was 8.5×7 cm (mean of 5.24×4.34 cm). The width of flap pedicle was kept at 4 cm maximum (mean=3.04 cm). All flaps were transported to the defect site by incising the intervening bridge, tunneling was not done. Fourteen patients did not have any co-morbidity, whereas four patients were chronic smokers, and three were diabetics. Flap survived completely in all patients. Three patients had partial graft loss and one patient had chronic discharge. Follow-up for maximum of six months (mean=4.04 months) were done. Conclusion: DBSAAF is a reliable flap for defects of distal leg and ankle region. Advantages are aesthetically better donor area, normal contour, and minimal scarring. It does not require a secondary debulking making it a one stage procedure and allowing patients to use their normal footwear.

Lateral Arm Flap: Its Usage as Pedicle and Free Flap.

IntroductionThe lateral arm flap is an excellent flap for both local and microvascular reconstruction. For local reconstruction on the upper extremity or as a distant microvascular flap, its advantages include short operation time, thin pliable tissue, non-dominant vessel, and minimal donor site morbidity. Moreover, it fulfills the goal of optimal reconstruction of form, function, and aesthetics. The objective is to share our experience of using the lateral arm flap, both as a free flap and as a pedicled flap.MethodsAfter taking exemption from the ethical review committee (ERC) of Aga Khan University Hospital, a retrospective data analysis of patients who had undergone lateral arm flap at the Plastic and Reconstructive Surgery department of the Aga Khan University Hospital was carried out from January 2012 to December 2019. The data examined included the patient's age, gender, diagnosis, location of the defect, size of the flap, and outcome of the flap at three weeks post-operation. For free flaps, data of the recipient artery used for anastomosis and the number of veins anastomosed were also included.ResultsOver a period of eight years, 33 lateral arm flaps were performed, including 23 free flaps and 10 pedicled flaps. The average size of the free flap was 12x6 cm and that of the pedicled flap was 8x5 cm. In the free-flap group, there was a failure in three flaps, two of which were due to arterial anastomosis in the zone of injury. There were no failures in the pedicled flap group.ConclusionThe lateral arm flap is a reliable flap, with consistent anatomy, which can be used for coverage in different parts of the body.

Spiralised supraclavicular artery island flap – a technical note

Introduction: The supraclavicular artery island flap (SCAIF) is a reliable flap with a range of applications in head and neck surgery. It is described in the reconstruction of pharyngeal defects following laryngopharyngectomy, but the width of the skin paddle required to form a circumferential reconstruction can make closure of the donor site difficult. Pharyngeal defects are typically 10–15 cm in height, and the described width of SCAIF which permits primary closure is 6 cm. A rolled flap would require a significantly broader donor site, and closure would therefore require skin grafting.

EDITORIAL COMMENT

The authors are to be commended for demonstrating the safety and efficacy of ureteral-appendiceal interposition.1 The results are interesting especially due to the inclusion of patients with left-sided or bilateral strictures and large number of patients with history of abdominopelvic radiation. The versatility of the appendix, as a convenient and reliable flap in the management of such strictures, is gaining prominence. With improved understanding of the importance of preserving ureteral blood supply, especially in radiation-induced strictures, appendiceal onlay, as opposed to ureteral transection and interposition, should also be considered.

En bloc resection and reconstruction in patients with advanced recurrent nasopharyngeal carcinoma and radiation-induced sarcoma of the head and neck

The purpose of this study was to assess the outcomes of patients with advanced recurrent nasopharyngeal carcinoma (rNPC) and radiation-induced sarcoma of the head and neck (RISHN) who underwent en bloc resection and reconstruction. Fifty-two patients with advanced rNPC (n=36) and RISHN (n=16) underwent en bloc resection and reconstruction with an extended lower vertical trapezius island myocutaneous flap (TIMF). En bloc resection of the tumour (including craniomaxillofacial resections and neck resections) and major defect restoration was successful in all patients. TIMF survival was 92.3%. Postoperative mild hemiplegia occurred in one patient with rNPC. In total, 20 patients (55.5%) in the rNPC group and seven (43.8%) in the RISHN group recovered with no signs of disease at follow-up. No statistically significant difference in recovery status was observed between the rNPC and RISHN groups. En bloc resection of the tumour, including dissection of the carotid artery, ensured microscopic clearance of the disease; this is a viable treatment option for patients with advanced rNPC or RISHN without distant metastasis. The extended vertical lower TIMF is a large, straightforward, and reliable flap for repairing the resultant major defects in the craniomaxillofacial or neck region.

Reconstruction of Head and Neck Region with Supraclavicular Artery Flap.

Although frequently used head and neck reconstruction methods are perforator flaps and free flaps, supraclavicular artery (SCA) flaps are newly used in skin defect reconstructions. In this study, we shared the experience of the SCA flap to evaluate whether there is a strong option in the head and neck. This prospective clinical cohort study of 28 patients, including 11 men, 12 women, and 5 children was performed between 2016 and 2020years in the patients who were planned with SCA flap for burns, tracheostomy, or after malignant skin tumor of head and neck region. Seventeen of our patients were burnt, 8 malignant skin tumors, and 3 were used to repair the wound that did not heal after tracheostomy. In one patient, the tissues could not be closed primarily because the skin lost its elasticity due to a burn in the surrounding tissues. No flap necrosis dehisens or any other complications were seen and our patients were discharged with complete recovery. While only two patients stated moderate satisfaction orally, the other patients liked the result very much. On the other side, all the patients declared no loss of functionality following this SCA flap surgery. The SCA proved itself as a strong reconstructive flap for the head and neck, and has consistently demonstrated a reliable flap to provide a perfect color match. II, Randomized clinical cohort study.

Wide posterior gluteal-thigh propeller flap for reconstruction of perineal defects.

With increasing popularity of minimally invasive approaches to abdominoperineal resection (APR), thigh-based flaps are becoming the preferred option for reconstruction. The gluteal-thigh flap provides sufficient bulk, albeit with a high complication rate. We reevaluated the vascularization and design of the gluteal-thigh flap. The purpose of this study is to highlight the importance of the vascularization of the posterior thigh skin by the descending branch of the inferior gluteal artery (IGA) and the profunda femoris artery (PFA) perforators to design a more reliable and versatile gluteal thigh flap. This flap is indicated in selected cases in which use of vertical rectus abdominis musculocutaneous flap is not feasible. Eleven fresh cadavers were used. The course, distribution, and diameter of IGA and PFA perforators were recorded. A wide posterior gluteal-thigh propeller flap (WPGTPF) was designed including the distance between the ischiatic tuberosity and greater trochanter; and extending it to within 8 cm of the popliteal fossa to improve flap reliability. Ten patients (mean age of 58.7 ± 10.6 years) underwent APR due to anal cancer (2) and rectal cancer (8); the approach was open in 3, laparoscopic in 6, and robotic in 1. All 10 patients received unilateral flap with a width of 12 ± 3.3 cm and surface of 405.5 ± 175.9 cm2 . The descending branch of the IGA was dominant in 72.7% of the specimens. In 22.7% of the specimens, the pedicle of the flap derived from the first or second PFA perforators. In one case, there was a double vascularization. Descending branch of the IGA was mapped at 46 ± 7.96 mm on the X-axis (horizontal line from the ischial tuberosity [IT] to the greater trochanter) and -12.1 ± 17.9 mm on the Y-axis (vertical line from the IT to the Medial Femoral condyle). Its average caliber measured 2.18 ± 0.3 mm. The first and second PFA perforators were located at 101.6 ± 17.9 mm and 104.5 ± 15.5 mm on the X-axis; 35.9 ± 27.1 mm and 89.2 ± 37.6 mm on the Y-axis. Their average diameters were 1.84 ± 0.41 mm and 1.48 ± 0.3 mm. In two cases, the flap was based on the first PFA perforator, the rest were on the descending branch of the IGA. Neither complete nor partial flap necrosis was observed. One patient developed coccyx osteomyelitis treated and resolved with bone debridement and one patient developed a seroma of the lateral thigh that was treated conservatively. Three patients underwent a debulking procedure by a combination of liposuction and resection to improve the gluteal symmetry. All ten flaps survived completely. Harvest of a wide flap that includes the PFA perforators and implementation of the propeller design increase the survival and versatility of the flap.

Cardioplastic Approach to Omental Flap Coverage for Severe Aortic Root Infections in the Opioid Era.

Summary:Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four patients were treated with pedicled omental flap coverage after aortic root reconstruction. All patients had successful flap healing with no evidence of recurrent infection. This series demonstrates the technical feasibility and clinical utility for providing soft tissue coverage and antimicrobial protection when used in aortic root reconstruction.

Breast reconstruction with the extended profunda artery perforator flap

The profunda artery perforator (PAP) flap is a reliable flap for breast reconstruction. By extending the traditional flap, it is possible to include more tissue and thereby enhance flap volume. The aim of this study is to demonstrate the technique for extended profundal artery perforator flap harvest and to demonstrate results in a population otherwise not suited for autologous breast reconstruction. Retrospective chart review of all patients who received extended PAP flap breast reconstruction between 2016 and 2018 was performed. Patient demographics, perioperative data, and postoperative complications were recorded in a pre-defined form and analyzed. A fully illustrated and step-by-step description of the procedure was created and included. A total of 46 extended PAP flaps for breast reconstruction were performed on 28 patients. Forty-three were 'regular' extended PAP flaps, one was a stacked flap, and two were transverse myocutaneous gracilis flaps with extended PAP flap skin design. Mean pre-operative breast volume was 330 cc, and mean flap weight was 400 g. The success rate was high (97.8%), and complications included one partial flap loss (2.2%), one wound dehiscence of the breast (2.2%), and wound dehiscence of the donor site (11 patients, 23.9%). The modified and extended profunda artery perforator flap is an excellent autologous tissue option for breast reconstruction even in large-breasted patients or patients with a relatively low body mass index. Advantages include higher flap volume, reliable blood supply, higher skin volume, and the possibility of choosing from several perforators, making dissection more convenient.

Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects.

This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5cm to 4.5 × 10.5cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.

Microsurgical reconstruction of extensive lower extremity defects with the conjoined parascapular and latissimus dorsi free flap

Extensive lower extremity soft-tissue defects pose a reconstructive challenge. We present our experience with the conjoined parascapular and latissimus dorsi (CPLD) free flap. From October 2008 to October 2017, 69 patients (14 female, 55 male) with a mean age of 50 years (range: 16-79 years) underwent reconstruction of lower extremity defects with the CPLD free flap. Mean defect size was 24 × 36 cm (range: 14 × 20 to 45 × 80 cm). Mean latissimus dorsi (LD) flap size was 19 × 28 cm (range: 14 × 20 to 28 × 42 cm) and mean parascapular (PSC) flap size was 8 × 25 cm (range: 5 × 12 to 11 × 33 cm). Six patients (9%) experienced a total of eight microvascular complications: arterial thrombosis (n = 1), venous thrombosis (n = 6), combined arterial and venous thrombosis (n = 1). The re-exploration rate was 13%. Major complications of the donor-site were seen in 9 patients (13%), of the flap in 13 patients (19%), and of both in 6 patients (9%). Fifteen patients experienced partial flap necrosis (22%). Three CPLD and one PSC flap were lost (5%). PSC flap length was a significant predictor of distal flap necrosis (χ2 (1) = 13.2, p = .004, OR = 1.343, 95% CI [1.098-1.642]). PSC flap width was a significant predictor of donor-site revisions (χ2 (1) = 15.9, p = .010, OR = 4.745, 95% CI [1.584-14.213]). Arterio-venous loops (AVLs) tended to increase the risk of microvascular thrombosis (χ2 (1) = 3.7, p = .08, OR = 4.1, 95% CI [0.9-18.7]). The CPLD free flap is an extremely large and highly reliable flap, allowing one-stage reconstruction of extensive lower extremity defects. It may overcome the need for multiple flaps in selected cases.

The contralateral based submental island flap for reconstruction of tongue and floor of mouth defects: Reliability and oncological outcome.

Submental artery island flap (SIF) is a viable alternative to free flaps for selected oral-cavity defects, however, concerns about its oncologic safety still exists. A novel harvesting technique and its outcome is described in here. This is a prospective study for patients with lateralized oral tongue and/or floor of mouth (FOM) cancers who undergone reconstruction using pedicled SIF based on contralateral submental vessels (CSIF) following resection. Forty-one patients were included. Twenty-four patients had T2, 13 had T3, and 4 had T1 tumors. The largest flap skin paddle was 15 × 9 cm. One patient sustained complete and five sustained partial flap loss. Three patients developed tongue tethering. Median follow-up was 13.6 months. Locoregional recurrence occurred in 11 patients (26.8%); 6 oral-cavity recurrences (14.6%), 6 ipsilateral, and 1 contralateral neck recurrences (2.4%). CSIF is a reliable flap that addresses the oncologic controversy and overcomes the disadvantages of ipsilateral flap.

Application and prospect of preoperative computed tomographic angiography in deep inferior epigastric artery perforator flap for breast reconstruction

To generalize the application and prospect of computed tomographic angiography (CTA) in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction. The related literature using CTA for DIEP flap reconstruction of breast in recent years was reviewed and analyzed. Preoperative CTA can accurately assess the vascular anatomy of the chest and abdomen wall, precisely locating the perforator in the abdominal donor site, and identifying the dominant perforator; guide the selection of intercostal space to explore internal mammary artery and internal mammary artery perforator in the chest recipient vessels. It can also reconstruct the volume of the abdominal flap with reference to the size of the contralateral breast and pre-shape the abdominal flap, which are crucial to formulate the surgical plan and improve the reliability of flap. Preoperative CTA has enormous application potential and prospects in locating donor area perforator, in selecting recipient vessels, and in evaluating breast volume for autologous breast reconstruction with DIEP flap.

Facial Artery Musculomucosal Flap for Nasopharyngeal and Oropharyngeal Reconstruction.

Importance: The facial artery musculomucosal (FAMM) flap is a well vascularized axial flap which has been described for mucosal reconstructions throughout the oral cavity. There are limited data regarding its efficacy in secondary repair of nasopharyngeal stenosis and velopharyngeal insufficiency due previous surgery and scar tissue formation. Objective: This study seeks to demonstrate the efficacy of FAMM flap procedure in patients with nasopharyngeal stenosis and velopharyngeal insufficiency. Design, Setting, and Participants: A retrospective case series included patients treated for nasopharyngeal stenosis or velopharyngeal insufficiency with a FAMM flap at an academic medical center from January 1, 2012 to November 1, 2017. Patients included in the study were those who underwent a FAMM flap procedure by the senior author during the specified time period. Main Outcomes and Measures: Functional outcomes included nasopharyngeal airway patency, nasal regurgitation, and speech quality. Any postoperative complications were recorded, including flap necrosis, infection, flap failure, dehiscence, trismus and need for revision surgery. Results: A total of 6 FAMM flap procedures were performed by the senior author over the study period for the indications of this case series. Three patients had nasopharyngeal stenosis and three had velopharyngeal insufficiency. All had successful, sustained nasopharyngeal airway patency or restored velopharyngeal function. The only postoperative complication noted was trismus at the cheek donor site. There were no patients who suffered flap failure or need for revision surgery of the FAMM flap. Conclusions: The FAMM flap is useful for secondary reconstruction of nasopharyngeal stenosis and velopharyngeal insufficiency due to previous surgery and scarring. This study demonstrates the efficacy and reliability of FAMM flaps for repair of complete/near complete nasopharyngeal stenosis and cases of velopharyngeal insufficiency due to scarring of the pharynx.

Reliability and Versatility of Reverse Sural Island Neurofasciocutaneous Leg Flaps.

Distally based sural neurofasciocutaneous (NFC) flaps are a commonly used method for foot and ankle reconstruction given that they are much simpler and, at the same time, still efficient alternative to perforator flaps and free style free flaps. This study aims to evaluate the reliability and versatility of reverse sural island NFC flaps as a powerful and efficient method that can be used for repair of lower leg skin defects. This method does not require microsurgical facilities or extensive training. Patients with soft tissue defects of the distal third of the leg and ankle region received reverse sural island NFC flaps. Inclusion criteria included an absence of damage to the sural neurovascular axis or communicating perforators, absence of peripheral vascular disease, and the presence of soft tissue defects deep enough to expose tendon or bone. Patients were assessed for flap (defect) size, pedicle length and location of defects, postoperative flap survival rates, and complications. Donor sites were closed directly or skin grafted. Of 24 consecutive patient (20 male; 4 female), all flaps except 1 (4.16%), survived, although partial necrosis was observed in 2 patients (8.33%). The overall major complication rate was 12.50%. Epidermolysis was noted in 1 patient (4.16%). Three cases of transient venous congestion resolved without additional complications. The overall minor complication rate was 16.66%. Minimal complications were associated with healing of donor sites. Reverse sural island NFC flaps provide adequate and aesthetically very acceptable coverage of soft tissue defects of the distal lower leg and proximal foot with no functional impairment.