Reverse Sural Artery Flap Research Articles

Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot

Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot

Complex Heel Defect: A Comprehensive Study On Combined Regional Flaps For Sensate And Stable Coverage.

BACKGROUND: Heel defect has remained a challenging situation for reconstructive surgeons. In large post traumatic defects, the goal is to provide a sensate and stable soft tissue coverage, especially for the weight-bearing part of the heel. The paucity of local tissue options makes the scenario difficult to deal with. OBJECTIVE: This study is aimed to reconstruct large defect, involving both the weight-bearing and non-weight-bearing part of the heel by combining two regional flaps. METHODS: A retrospective study, comprising of 11 patients from January 2016 to December 2019 with large traumatic heel defects, operated in our setup with combined medial plantar and reverse sural artery flap within 72 hours of injury. Follow up period was 6 months postoperatively. RESULT: All flaps survived well except one reverse sural flap, which was congested and later debrided and 2 had distal edge necrosis which were managed conservatively. All the reverse sural flaps were noted to have lymphedema, but only 3 patients opted for debulking surgery. The functional outcome was excellent, with all the patients being able to walk normally, both barefoot and with footwear. The weight-bearing area was sensate, a clear advantage of utilizing instep skin. CONCLUSION: In our experience, the combined strategy of utilizing local tissue for large heel defects, not only provides a sensate, stable, and reliable coverage but also avoids the lengthy procedure of free tissue transfer that in the end would not be able to give similar results.

Surgical Experience of Reconstruction of Distal Lower Limb Soft Tissue Defect with Reverse Sural Artery Flap with Cutaneous Pedicle

Background: The soft tissue reconstruction of distal leg, ankle and foot is always challenging to orthopaedic surgeons. Among many available options, the reverse sural artery flap is technically easy local option to cover soft tissue defect. We aim to share our experience of reverse sural fasciocutaneous flaps for reconstruction of distal leg soft tissue defect.
 Materials and Methods: An observational retrospective study was conducted on all cases that had undergone reverse sural flap surgery between February 2019 to January 2023 in orthopedic department of Nobel Medical College Teaching Hospital. The following variables were gathered for analysis: hospital stay duration, postoperative complications, etiology and duration of the wound, wound site and size, number of surgeries, associated trauma, surgery time and technical details, and final outcome in terms of flap survival.
 Results: Out of 20 cases, sixteen were male and 4 were female. The mean age was 36 years. Seven cases (35%) had associated comorbidities. The most common etiology was trauma and most common sites was ankle and calcaneus (60%) followed by distal leg (35%) and foot (5%). The graft survival rate was 85%. Three cases (15%) had partial flap necrosis and one (5%) had venous congestion.
 Conclusion: The reverse sural artery flap is easy, versatile and reliable technique to cover soft tissue defect in distal leg, ankle and foot.

Reconstruction of Achilles Tendon Skin Defect Using Single-Stage Reverse Sural Artery Island Flap

Wound complications following open repair of a ruptured Achilles tendon are common and require immediate skin cover. This study analyses the use of a reverse sural artery island flap to cover skin defects over an exposed intact Achilles tendon. Thirteen patients with postoperative wound complications over the tendoachilles were operated upon. All wounds were debrided and reconstructed with a single-stage reverse sural artery island flap. Within 5 weeks of flap cover, 12 wounds healed completely, while 1 flap had superficial necrosis at the margin in a diabetic patient. This eventually healed and did not compromise the final result. None of the flaps had venous congestion. In our hands, reconstructing skin defects following wound complications after Achilles tendon repair with islanded reverse sural artery flap is a reliable and safe option. Level of Evidence: Level IV.

Reverse Sural Artery Flap: Anatomic Study of Peroneal Perforators and Clinical Modifications for Coverage of Medial and Distal Foot Defects

Reverse Sural Artery Flap: Anatomic Study of Peroneal Perforators and Clinical Modifications for Coverage of Medial and Distal Foot Defects

Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap.

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.

Reverse sural artery flap for posterior ankle soft tissue defect

Background and aim Soft tissue defects of the ankle provide a significant challenge to reconstructive surgeons. Several techniques have been documented for this reconstruction, and all of these techniques varied in cost, difficulty, and outcomes. This study aims to evaluate the reverse sural artery flap for posterior-ankle soft tissue defect reconstruction. Patients and methods Nine patients with posterior ankle soft tissue defects due to different etiologies and requiring reconstruction were included and operated in the reconstructive microsurgery unit of Al-Azhar University Hospital, Assiut, Egypt, during the period between 2019 and 2022. These defects were covered by the reverse sural artery flaps. The follow-up period ranged from 18 to 36 months, and all the patients were evaluated for functional outcomes in terms of ulceration, sensation, patient satisfaction, and complications. Results All flaps survived with no complications. The mean operative time was 1.4±0.33 h. (1–2 h) and the mean hospital stay period was 2.4±0.52 days. Postoperatively, ulceration was recorded in 2 (22.2%) cases and sensation in all cases and the majority of patients were satisfied with the results (8 cases, 88.9%). Five cases had good Maryland score (55.6%), 2 (22.2%) cases had excellent, and only 1 case was recorded for poor and fair scores. All the defects were covered effectively with no complications. Conclusion The reverse sural artery flap could be one of the effective treatment methods for reconstructing posterior-ankle soft tissue defects. Besides, it has high reliability, ease, and versatility.

Comparison of single-stage reverse sural artery flap versus two-staged interpolated flap in distal lower limb injuries

<p><strong>Background and Objective</strong>: Plastic surgeons face challenging conditions when dealing with soft tissue injuries or defects involving the lower part of the leg and the proximal part of the foot. The objective of the current study is to compare single-staged reverse sural artery flaps with two-staged interpolated flaps in distal lower limb injuries.</p>
 <p><strong>Methods</strong>: It was a prospective study carried out at the Department of Plastic Surgery, Allama Iqbal Memorial Teaching Hospital, Sialkot, Pakistan, over 5 years from 2015 to 2020. Sixty-eight (n = 68) patients with distal lower limb soft-tissue defects were enrolled and randomly allotted a two-stage interpolated flap design (group A) or single-stage reverse sural artery flap design (group B). The measured outcomes included the frequency of flap-tip necrosis, epidermolysis, partial or total flap loss, and additional procedures needed for managing these complications.</p>
 <p><strong>Results</strong>: Out of all the patients, 72% were of male gender and 28% were females with a mean age of 38.38 ± 10.76 years. In group A, there were 6% of the cases where tip necrosis was the only impediment as compared to 17% in group B. In patients of group A, epidermolysis was seen in 12% as compared to 35% in group B whereas only 6% of patients in group A required secondary procedures for flap tip necrosis as compared to group B (47%). Paired t-test was used to calculate the statistical significance of the outcome between the two groups (p-value of 0.0491).</p>
 <p><strong>Conclusion</strong>: The two-staged interpolated flap procedure results in fewer complications as compared to a single-staged reverse sural artery flap procedure. However, the shorter hospital stay in single-staged flap design is satisfying for the patients who did not report any complications with this procedure.</p>

Delayed Reverse Sural Artery Flap with Skin Pedicle Technique Versus Standard Island Sural Artery Flap for Reconstruction of Lower Leg, Ankle and Malleoli

Background and objectives: Standard reverse island sural artery flap is the most common usage for distal third defects of the leg. However many authors reported 36 % complication rate mainly partial or complete flap loss , that is attributed to venous congestion. Delayed reverse sural artery flap in two stages with skin pedicle technique is reliable and less complicated. In this study was compare between the results of both techniques.
 Patients & Methods: The study included forty patients presented to AL-Wahda University Hospital and 48 Military Hospital , after trauma of lower leg with complete loss of soft tissue and exposure of underlying structures ,within periods Oct 2013 to May 2017. The patients were thirty male and ten female , their age ranged between fifteen to sixty years old . Reverse island sural artery flap was used in twenty patients, while delayed sural artery flap was used in twenty patients too.The results of both techniques were compared.
 Results: In our study the standard reverse island sural artery flap is good option for reconstruction of lower leg , ankle and malleoli defect ,which is performed in twenty patients , the partial necrosis occur in 20% patients and three cases with flap failure ,the venous congestion occur in 35% of patients In this study, we performed reconstruction of the lower leg, heel , and malleoli in another twenty patients by delayed reverse sural artery flap with skin pedicle technique, the flap necrosis occur only in one case and partial flap necrosis occur in two cases only, in comparison with standard technique of reverse island sural artery flap, the venous congestion occur only in four patients 20% , two cases recovering the congestion by leg 
 elevation and improving the patients hydration , and two cases of venous congestion progressive to partial flap necrosis. Partial necrosis occur in two cases, complete flap necrosis occur in one case and 95% of patients satisfaction in discharge.
 Conclusion: The delayed reverse sural artery flap with skin pedicle is very important to avoid of venous congestion and flap failure , especially in old patients , DM , and in patients with peripheral vascular diseases. The goal of our study were achieved , and the patients improved functionally and attained their routine activity. By this technique and modification, make the delayed sural artery flap the first choice in reconstruction of the lower third defect of leg , heel and ankle. and is less postoperative venous congestion and flap failure. Delayed sural artery flap in two stages with skin pedicle technique is convenience and less complication particularly for old patients with diabetes mellitus and peripheral limb ischemia or venous insufficiency.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

Distally Based Sural Flap in Children: Experience in Our Department

The reverse sural artery flap (RSAF) was first described approximately four decades ago in 1983 by Donski and Fogdestam [1] and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Coverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in children, to get a global experience with the sural flap in our department of plastic and reconstructive pediatric surgery, and to describe the complications. Material and methods: A distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 5 paediatric patients between 2018 and 2021. The median age of patient at surgery was 6 years old. The most frequent mechanism of soft tissue defect was trauma caused by vehicular accident (open fractures) crush injuries, lacerated wound. Results: One of the 5 flaps was a cross leg sural flap, 4 recovered well without necrosis, only one developed partial necrosis requiring excision and skin grafting. The other complications where an early postoperative complications: partial or total necrosis of the flap late complications including impaired touch sensation over the flap and donorsite. Discussion: The distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a good blood supply. When there is exposure of a vital structure, distal sural flap is the best indication for coverage in a traumatic soft-tissue defect. The use of a distally based sural fascio cutaneous flap is not free from delayed complications most of them at the donor site.

Resurfacing the donor sites of reverse sural artery flaps using thoracodorsal artery perforator flaps.

BackgroundThe reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps.MethodsFrom April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases).ResultsEight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021).ConclusionsPlanning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

Caveats of Local Fasciocutaneous Flaps for Distal Leg Defects—Anatomical Study and Clinical Application

The present trend for the management of distal leg defects is to opt for a free flap with local flaps being relegated to the backseat. We studied the perforator anatomy of the distal leg in the Indian population to see if there were any ethnic differences and then correlated it with a clinical study of local flaps used for the coverage of distal leg defects. A prospective observational study was carried out in 2 phases—anatomical study and clinical study from December 2018 to March 2020. In the anatomical study, 8 fresh cadavers, i.e., 16 lower limbs were dissected and the perforator anatomy in the distal leg was identified. In the clinical study, all patients undergoing local, pedicled fasciocutaneous flap cover for defects involving distal third leg were included with ages between 15 and 60 years. In the anatomical study, posterior tibial artery perforators in the distal-most part were found as a group of up to 3 perforators. In the clinical study, a total of 47 patients were included with a mean age of 38.0 ± 10.9 (range 17-55) years and female:male ratio being 1:2.6. The largest defect size was 120 cm2 (mean 28.2 ± 23.8 [range 6-120] cm2) and the most commonly used flap was the reverse sural artery flap in 20 (42.6%) cases. Overall, complications were seen in 7 (14.9%) cases and there was no case of flap failure. Thus, local flaps are an excellent option for coverage of distal leg defects and offer results comparable to free flaps.

Long-Term Clinical and Functional Outcomes of Distally Based Sural Artery Flap: A Retrospective Case Series

BackgroundReconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome. MethodsA retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect site and size, size of flap, hospital stay, complications, outcome of flap and functional status of limb. Data analysis was performed by using SPSS version 25.0. ResultsWe included 89 patients out of 106, with 92 distally based sural artery flaps. The flap coverage was divided in two groups: group I for leg (n=41) and group II for foot (n=51). The mean flap dimension in leg was 9.98 ± 2.2 cm and 12.15 ± 3 cm in foot. Postoperatively functional outcomes were assessed using a self-designed tool and graded as excellent in 79 cases (leg=38; foot=41), good in 10 cases (leg=2; foot=8), fair in 3 cases (leg=1; foot=2) and poor in zero cases. All flaps survived uneventfully. ConclusionThe reverse sural artery flap is versatile and reliable, and can be performed easily with good knowledge and using a microsurgical technique. It is useful for the reconstruction of soft tissue defects around the lower third of the leg, dorsum of the foot, malleoli and hind foot. The functional range of motion of the ankle is not compromised because of the flap's supple and pliable nature. The reverse sural artery flap is ideal for the coverage of the foot, ankle and lower one third of the leg. This flap is insensate and not suitable for the weight-bearing area of the heel.

Single Stage Reconstruction of Posterior Soft Tissue Ankle Defects with a Free Anterolateral Thigh Flap and Rolled Tensor Fascia Lata for Functional Tendo-Achilles Reconstruction - A Case Report and Review of the Literature

Soft tissue defects in the posterior ankle region with underlying Achilles tendon loss pose a reconstructive challenge to both Orthopaedic and Plastic surgeons. Such injuries can result in a severely debilitating sequelae for the patient, therefore reconstruction of the area must provide reliable function and durability with minimal complications and aesthetically pleasing results to enable normal foot wear. We describe the case of a twenty-seven year old male, who presented following a traumatic open rupture of the Achilles tendon and failed reverse sural artery flap. We performed a single stage composite soft tissue reconstruction with a free anterolateral thigh (ALT) flap and rolled vascularised Tensor Fascia Lata (TFL) for functional Achilles tendon reconstruction. The patient had no post-operative complications and was able to fully weight bear and dorsiflex his foot beyond ninety degrees at seven month follow-up. Whilst many options are available to reconstruct this area, we review the literature to illustrate the advantages of using this technique to achieve all of the above factors, and advocate for all foot and ankle surgeons to be aware of its use in their reconstructive repertoire.

Post road traffic accident one-month old, extra-large heel defect coverage by delayed reverse sural artery flap: an interesting case report

Post road traffic accident (RTA) complete heel avulsion injury is not very common, but once it happened, it is very challenging to plastic and reconstructive surgeon to reconstruct the total heal avulsion defect. There is paucity of soft tissue in the region of foot, ankle and lower one third of leg. Although the micro vascular free flap reconstruction is gold standard for reconstruction of large heel defect but not feasible most of the time. Reverse sural artery flap (RSAF) is a workhorse flap for reconstruction of heel and lower 1/3rd leg defect. Here we reported a case of 28 years old young man, who had road traffic accident and sustained complete right heel avulsion injury with calcaneal and right tibia bone fracture. Patient was presented to author one month later after the injury with extra-large infective right heel defect size 15×12 cm with k-wires in exposed calcaneal bone. Patient’s surgery was done in two stages. Delayed RSAF survived completely and well settled in our case.

Versatility of Reverse Sural Artery Flap for Coverage of Heel and Proximal Foot Defects in Children

Objective: The objective of the study was to determine the versatility of reverse sural artery flap in terms of its reliability and efficacy for reconstruction of soft-tissue defects of heel and proximal foot in children. Material and Methods: A total of 30 patients aged 5-13 years with ankle and foot defects admitted to the Plastic Surgery and Burn department at the Sheikh Zayed Hospital, Rahim Yar Khan from January 2018 to July 2020 were studied by designing a retrospective cross-sectional case series study. Results: Out of 30 flaps, 26 (86.7%) healed fully, whereas 4 (13.3%) complicated by partial necrosis requiring a secondary procedure. Nineteen (63.3%) patients had wheel spoke injuries, eight (26.6%) sustained degloving injury after a road traffic accident, and three (0.1%) patients were having a history of electric burn. In 22 patients an interpolated flap was used and in 8 cases an islanded flap. Donor sites were skin grafted in all patients. Two patients developed hypertrophic scarring at donor area. All patients showed good functional results, however flap remained insensate throughout the follow-up period that was minimum for 6 months. Conclusion: The reverse sural artery flap is versatile, reliable and a method of choice in reconstructing soft-tissue defects of the hind foot in children. This flap is easy to dissect, has robust blood supply and does not sacrifice any major blood vessel of the leg. Key Words: Reverse Sural Artery Flap, children, Ankle and Foot, Soft-tissue Defects, Wheel Spook Injury

A Single-Center Surgical Experience With the Reverse Sural Artery Flap as a Reliable Solution for Lower Leg Soft Tissue Defects, With Minimum Two-Year Follow-Up.

Aim: Small soft tissue defects of the distal tibia and hindfoot resulting from traumatic, operative, or neoplastic conditions and chronic ulcers can be successfully dealt with the use of the reverse sural artery flap (RSAF). This study aims to describe a single center’s results and familiarity with this technique over a 15-year period of time.Material and methods: We retrospectively reviewed the clinical files of patients who were consecutively treated with RSAF and regularly followed up between January 1, 2004 and December 31, 2018, with a minimum postoperative follow-up period of two years. Patient demographics and comorbidities, location of the defect, performing surgeon, mean operation time, flap pedicle width, mean size of the defect, days of hospitalization following the operation, healing flap rate, and complications were recorded.Results: The sample consisted of 30 adult patients (25 men, 5 women), with a mean age of 51.07 years (16-80 years, SD 18.61). The mean operation time was 99.03 min (range 83-131, SD 10.57), and the mean size of the defect was 11.11 cm2 (range 6.1-19.4, SD 3.22). Successful flap rate (complete healing and coverage of the defect, with or without additional minor intervention) was 83.3% (25/30). Among successfully healed flaps, six patients with partial necrosis of the dermis were treated by an additional split-thickness skin graft. Five flaps failed to heal. Deep infection was present in two patients, leading to flap failure and reoperation. Serious venous congestion resulting in flap ischemia occurred in three cases. Circumferential keloid formation (not affecting successful outcome) was present in seven cases. Flap thickness approximated to normal within six months. All donor sites healed well (either by a split-thickness cutaneous flap or by immediate wound closure). Light paresthesia on the lateral border of the leg and foot disappeared within six months.Conclusions: A single-center experience with the RSAF has yielded satisfactory clinical outcomes, and the long-term tackle with the difficult reconstruction conditions around the ankle, has led to valuable advice on surgical technique and postoperative protocol, based on an anatomical basis.

Reconstruction of the weight-bearing heel with nonsensate reverse sural artery flaps

BackgroundThe reverse sural artery flap (RSAF) is widely used to reconstruct foot and ankle defects. Although it is commonly used in a nonsensate type, there has been controversy as to whether it provides sufficient stability and durability when applied to weight-bearing heels. The aim of this study was to evaluate patient outcomes after weight-bearing heel coverage using a nonsensate RSAF. MethodsTwenty-three patients who underwent reconstruction surgery of the weight-bearing heel with RSAF from 2004 to 2018 in a tertiary hospital were retrospectively reviewed. All surgeries were performed without a sensate procedure. The patients’ experience of pressure sore on the flap area and the ability to use normal footwear were investigated. Light touch, Semmes-Weinstein test (SWT), and two-point discrimination tests were assessed, along with postoperative wound complications. ResultsHeel damage etiologies included malignant tumors in 14 (61%), trauma-related in 7 (30%) and diabetic ulcers in 2 (9%) patients. Patient mean age was 58 years (range, 18–93 years) and the mean follow-up period was 57 months (range, 12–185 months). The mean size of the flap was 64.1 cm2 (range, 20–169 cm2). All flaps healed without major complications. All returned to daily living activities and 20 (86%) patients were able to use normal footwear. Of the 11 patients who had available measurement records, 8 (73%) showed a light touch sense. The mean SWT value was 4.31 (range, 3.61– 4.56). Two-point discrimination was not observed in any of the patients. Two patients had experienced superficial ulcers on the flap within a one-year postoperative period, which spontaneously healed and did not recur. No full-thickness ulcers were observed during the follow-up period. ConclusionsThe results of this study suggest that patients who underwent nonsensate RSAF for the reconstruction of the heel could expect to maintain the property for stable weight-bearing without pressure sore.

Versatility of Reverse Sural Artery Flap (RSAF) in management of lower limb defects: Our experience

Background: Wounds around the lower 1/3rd of leg and foot are difficult to manage. Treatment options like skin grafting, healing by secondary intention can result in an unstable scar. Free tissue transfers and Regional flaps has its own disadvantages. To circumvent these difficulties a fasciocutaneous flap harvested from sural angiosome was proposed. In this study, we have made an attempt to find out different scenarios in which this flap can be used as a management option and ways to minimize the complications associated with this flap. Methods: A retrospective observational study was conducted over 2 years. 30 patients were studied. Patient details was obtained from the case record, operative notes and postoperative follow-up.Results: Patients between the age of 10 years to 65 years were studied. RSA flap with adipofascial pedicle and fasciocutaneous pedicle was done in 21 and 9 patients respectively. Delaying of flap was done in 9 patients, with most common indication as distal defect. Common site of defect which were reconstructed was on the Tendoachilles region, Heel region. Various complications were loss of graft used to cover adipofascial pedicle, Venous congestion, hematoma formation and partial skin necrosis of the flap. None of the patients complained of any effect on routine activity during postoperative follow up.Conclusion: It is a versatile flap and different scenario can be managed with customization in plan. With proper selection of patients, it can be judiciously used to manage different leg defects.