Reverse Sural Flap with an Adipofascial Extension for Reconstruction of Soft Tissue Defects with Dead Spaces in the Heel and Ankle

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2015 Sep 30

PMID 26416400

Citations 6

Authors

L Zheng

J Zheng

Z G Dong

Affiliations

Soon will be listed here.

Abstract

Introduction: The reconstruction of soft tissue defects with dead spaces in the heel and ankle is challenging. This article describes our experience in the reconstruction of such defects using the reverse sural flap with an adipofascial extension.

Method: Reverse sural flaps with an adipofascial extension were used in 26 patients with soft tissue defects in the heel (n = 24) or ankle (n = 2). Extended adipofascial tissue was utilized to fill the dead space. The sizes of the adipofascial extensions varied from 2.0 to 5.0 cm in length and 4.0 to 12.5 cm in width.

Result: Twenty-three flaps survived completely, and lateral marginal necrosis occurred in three flaps. All the recipient-site wounds healed without any signs of infection. The reconstruction outcomes were excellent in 20 patients and good in 6 patients according to the criteria of Boyden et al.

Conclusion: The extended adipofascial tissue of the reverse sural flap improves closure of the dead spaces in soft tissue defects of the heel and ankle and thus provides beneficial conditions for the treatment of infection and reconstruction of both the function and contour of the soft tissue defects with dead spaces in the heel and ankle.

Citing Articles

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How Safe Is Reverse Sural Flap?: A Systematic Review.

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PMID: 33728136 PMC: 7936390. DOI: 10.7759/cureus.13118.

References

Tajsic N, Winkel R, Hoffmann R, Husum H . Sural perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 86 patients with post-traumatic osteomyelitis. J Plast Reconstr Aesthet Surg. 2008; 62(12):1701-8. DOI: 10.1016/j.bjps.2008.06.091. View

Herlin C, Lievain L, Qassemyar Q, Michel G, Assaf N, Sinna R . [Freestyle free perforator flaps for heel reconstruction]. Ann Chir Plast Esthet. 2012; 58(4):283-9. DOI: 10.1016/j.anplas.2012.08.005. View

Chai Y, Zeng B, Zhang F, Kang Q, Yang Q . Experience with the distally based sural neurofasciocutaneous flap supplied by the terminal perforator of peroneal vessels for ankle and foot reconstruction. Ann Plast Surg. 2007; 59(5):526-31. DOI: 10.1097/01.sap.0000258969.13723.68. View

Chang S, Zhang F, Xu D, Yu G, Hou C, Lineaweaver W . Lateral retromalleolar perforator-based flap: anatomical study and preliminary clinical report for heel coverage. Plast Reconstr Surg. 2007; 120(3):697-704. DOI: 10.1097/01.prs.0000270311.00922.73. View

Parrett B, Pribaz J, Matros E, Przylecki W, Sampson C, Orgill D . Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction. Plast Reconstr Surg. 2009; 123(5):1499-1504. DOI: 10.1097/PRS.0b013e3181a07723. View

Salgado C, Mardini S, Jamali A, Ortiz J, Gonzales R, Chen H . Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg. 2006; 118(6):1401-1411. DOI: 10.1097/01.prs.0000239579.37760.92. View

Battiston B, Antonini A, Tos P, Daghino W, Massazza G, Riccio M . Microvascular reconstructions of traumatic-combined tissue loss at foot and ankle level. Microsurgery. 2011; 31(3):212-7. DOI: 10.1002/micr.20863. View

Bocchi A, Merelli S, Morellini A, Baldassarre S, Caleffi E, Papadia F . Reverse fasciosubcutaneous flap versus distally pedicled sural island flap: two elective methods for distal-third leg reconstruction. Ann Plast Surg. 2000; 45(3):284-91. DOI: 10.1097/00000637-200045030-00011. View

Chang S, Zhang K, Li H, Huang Y, Zhou J, Yuan F . Distally based sural fasciomyocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel. Microsurgery. 2008; 29(3):205-13. DOI: 10.1002/micr.20595. View

10.

Mueller J, Ilchmann T, Lowatscheff T . The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture. Arch Orthop Trauma Surg. 2001; 121(6):350-2. DOI: 10.1007/s004020000238. View

11.

Vergara-Amador E . Distally-based superficial sural neurocutaneous flap for reconstruction of the ankle and foot in children. J Plast Reconstr Aesthet Surg. 2008; 62(8):1087-93. DOI: 10.1016/j.bjps.2008.02.004. View

12.

Mehrotra S . Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg. 2007; 119(2):590-8. DOI: 10.1097/01.prs.0000239570.18647.83. View

13.

Yildirim S, Gideroglu K, Akoz T . The simple and effective choice for treatment of chronic calcaneal osteomyelitis: neurocutaneous flaps. Plast Reconstr Surg. 2003; 111(2):753-60; discussion 761-2. DOI: 10.1097/01.PRS.0000041446.73584.28. View

14.

Yang C, Geng S, Fu C, Sun J, Bi Z . A minimally invasive modified reverse sural adipofascial flap for treating posttraumatic distal tibial and calcaneal osteomyelitis. Int J Low Extrem Wounds. 2013; 12(4):279-85. DOI: 10.1177/1534734613511637. View

15.

Lu T, Lin C, Lin C, Lin Y, Chen R, Wei F . Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg. 2010; 64(3):386-93. DOI: 10.1016/j.bjps.2010.05.004. View

16.

Yazar S, Lin C, Lin Y, Ulusal A, Wei F . Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg. 2006; 117(7):2468-75. DOI: 10.1097/01.prs.0000224304.56885.c2. View

17.

Jakubietz R, Jakubietz D, Gruenert J, Schmidt K, Meffert R, Jakubietz M . Reconstruction of soft tissue defects of the Achilles tendon with rotation flaps, pedicled propeller flaps and free perforator flaps. Microsurgery. 2010; 30(8):608-13. DOI: 10.1002/micr.20798. View

18.

Jepegnanam T, Nithyananth M, Boopalan P, Cherian V, Titus V . Reconstruction of open contaminated achilles tendon injuries with soft tissue loss. J Trauma. 2009; 66(3):774-9. DOI: 10.1097/TA.0b013e31817c96c7. View

19.

Fodor L, Horesh Z, Lerner A, Ramon Y, Peled I, Ullmann Y . The distally based sural musculoneurocutaneous flap for treatment of distal tibial osteomyelitis. Plast Reconstr Surg. 2007; 119(7):2127-2136. DOI: 10.1097/01.prs.0000260596.43001.05. View

20.

Al-Qattan M . The reverse sural artery fasciomusculocutaneous flap for small lower-limb defects: the use of the gastrocnemius muscle cuff as a plug for small bony defects following debridement of infected/necrotic bone. Ann Plast Surg. 2007; 59(3):307-10. DOI: 10.1097/SAP.0b013e31802e094e. View