Fasciocutaneous flap choices to treat dorsal surface of foot defects. Patients and methods from 1998 through 2005, we treated 52 patients with ankle, heel, sole, distal leg, and foot defects. Introduction wounds around the lower third of the leg and foot are difficult to manage because of the composite tissue defects, inadequate and tight local tissues and poor circulation. The reverse sural artery flap is an effective technique for closing these defects and saving the limb. Reverse flow sural flap al azhar assiut medical journal. In recent years, the authors have favored the reverse sural artery fasciocutaneous flap in 11 patients for its ease of dissection, limited morbidity, and preservation of major vessels to the limb.
The reverse sural artery flap is a reliable alternative for treating small to moderate size defects of the lower tibia, ankle, and heel regions. Reverse sural flaps have been used for this problem. A distally based superficial sural artery flap was performed in each patient. Since the introduction of this flap by masquelet 3 in 1992, it has become one of the favourite among reconstructive surgeons. This is a case report of a 24 years old male who had gustillo and anderson. Reverse sural artery flap christopher finkemeier, md on. Use of expanded reverse sural artery flap in lower extremity. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. The reverse flow island sural flap is presented as an alternative to flaps. The reverse flow sural flap was used in the reconstruction of 18 defects. Clinical study comparison between peroneus brevis flap and reverse sural artery flap for coverage of lower onethird leg defects.
Objective soft tissue injuries at the level of lower extremities, plantar, and dorsal foot pose a surgical challenge for reconstructive surgeons. To overcome this, we have modified our operative technique, which has produced a more reliable flap. In the present report, the results of reverse flow sural neurocuta. Background softtissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon. Hidden camera investigation on what really happens to your car cbc marketplace duration. This technique had not been mentioned in the literature before as far as we know. Fascio cutaneous flap, foot and ankle, reverse sural artery, reverse sural flap, sural nerve 1. The sural reverse flap is useful in the ankle and foot soft tissues. Sural artery flap remains a viable option for the reconstruction of soft tissue defects of the distal third of the leg and foot. Reverse sural artery flap has been proven to be an effective option to cover such defects. The most accessible flap is the reverse sural artery flap, which can be harvested as a fasciocutaneous flap or an adipofascial flap. The flap consists of superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery. A compromised cosmetic donor site and increased flap necrosis rate in highrisk patient groups have made many surgeons reluctant to use the sural flap.
Effectiveness of reverse sural artery flap in the management of wheel spoke injuries of the heel figures etc. Video shows the technique for a reverse sural artery flap used to cover a full thickness skin loss over the calcaneal tuberosity from delay in treatment of a severely displaced tongue type calcaneus fx. The reverse superficial sural artery flap revisited for. One of the advantages of this thin fasciocutaneous flap is that it permits skin coverage with ideal contouring. Twenty patients comprising of males and 7 females with soft tissue defects of the lower third of the leg and foot requiring soft tissue cover were treated between january 2006 and december 2010. Reverse sural fascio cutaneous flap for soft tissue coverage. The reverse sural artery fasciocutaneous flap is a versatile soft tissue coverage procedure for traumatic soft tissue defects of the distal tibia, ankle, and foot. Caveats for successful performance of the reverse sural artery flap include doppler evidence of patent peroneal perforators, placement of a lazy tshape skin paddle over the distal gastrocnemius muscle bellies, inclusion of the lesser saphenous vein to augment venous drainage, and, lastly, careful dissection to provide a wide adipofascial pedicle. The distally based superficial sural artery flap for coverage of calcaneal defects abdul hameed, shaheen akhtar, fahim anwar, abdul waheed, shahnab ahmed.
Two of these patients had significant comorbidities of haemoglobinopathy and poorly controlled diabetes mellitus. Large soft tissue defects around the lower third of the leg, ankle and foot always have been challenging to reconstruct. Comparison between peroneus brevis flap and reverse sural. Different types of flaps can be designed based on its pedicle and. A total of 71 patients were operated on with this technique, some of them with. Warrelated blast injuries represent a unique injury mechanism. Different studies, however, speak of its use in different areas depending upon the individual experiences. There was satisfactory flap healing in 17 patients 85%, while 3 patients 15% had complete flap necrosis. Donski and fogdestam, in 1983 described the flap and later by the year 1992 championed by masquelet et al. The distally based superficial sural artery flap for coverage. The sural nerve remains the anatomic landmark for the inclusion of vessels in pedicle of the flap. Is it safe to extract the reverse sural artery flap from.
Pm references 1 tsai j, liao ht, wang pf, chen ct, lin ch. The success of the reverse sural flap is predicated on the ability to correctly incorporate its vascular supply which is based off the sural nerve and, to a greater extent, the sural artery which provides the true vascular network as it continues into the retromalleolar region and communicates with several anastomoses with the peroneal artery. Extraction of reverse sural artery flap from the proximal third of the leg 180 archives of iranian medicine, volume 11, number 2, march 2008 the reversed sural flap harvested from the proximal third of the leg. The sural artery reverse flow flap is nourished by the lowermost perforating branch of the peroneal artery. A 47yearold man with a calcaneal defect from chronic osteomyelitis. Surgical anatomy of the medial sural artery perforator flap. The reverse superficial sural artery flap rssaf is a popular option for many of these difficult wounds. The reverse sural artery flap for the reconstruction of. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be. Reverse sural artery flap for the reconstruction of chronic. Reverse sural artery flaps can also be used to cover the calcaneus and deep heel wounds. Preoperatively, the medial calf was examined with the handheld doppler.
Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. The reverse flow sural flap has been featured as a relevant option for recons truction of. The reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. The flap was distally based, islanded and covered the area with vascularised. The reverse sural artery flap is a useful flap for defect reconstruction in the distal leg, ankle and. The distally based neurofasciocutaneous reverse sural flap, 11 x 12 cm in size was transferred to the defect through the subcutaneous tunnel. The reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel. This is a random type of flap, based on the reverse flow of the superficial sural artery. Sep 22, 2015 adipofascial flap with wide pedicle in the late group. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Superficial sural artery neurocutaneous flap is an island flap based on vascular axis of sural nerve which gets reverse vascular flow through communication with the septocutaneous perforating branch of the peroneal artery.
This pedicle is 5cm proximal to the tip of the fibula posteriorly and will be the pivot point of the pedicle. Apr 02, 2016 the main perforators of the medial sural artery are located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. The preferred perforator was the one figure 1 the medial sural artery divides into two. To demonstrate the technical aspects of a reverse sural artery rsa flap. A modified technique for transposition of the reverse sural artery flap. The length of the pedicle is identical to the distance between the rotation point of the flap and the wound. Aug 11, 2009 an defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. Fasciocutaneous flap with wide pedicle in the late group. Preoperative left and postoperative right picture of the left foot of a 15yearold girl, which was repaired with reverse sural artery flap. A comparison of fasciocutaneous and adipofascial methods in. Dec 31, 2016 the reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel.
Figure 6 a a 22yearold male presented with a left foot degloving injury with. Use of expanded reverse sural artery flap in lower. This flap depends on the retrograde flow through the median superficial sural artery from the peroneal artery through the posterolateral ankle perforators. The age and sex of each patient, cause, dimension of flap, transposition of pedicle through a tunnel or laid open and covered with a skin graft, postoperative results and complications were recorded. Defects at this site will often require flap cover. Ota video library reverse sural artery flap christopher. The reverse superficial sural artery flap revisited for complex. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. There are no reports on use of this reconstructive flap in treating highly contaminated warrelated musculoskeletal trauma of the foot and ankle. When contraction was released by an operation, a wide defect was created. The distally based superficial sural artery flap for. Patients and methods from 1998 through 2005, we treated 52.
Once this pivot point is determined, the length of the pedicle can then be determined with suture or a paper ruler. Surgical anatomy of the medial sural artery perforator flap wong et al. A comparison of fasciocutaneous and adipofascial methods. The aim of this study is to analyze the demographic.
A outline of the flap and the calcaneal defect before debridement. In conclusion, expansion and delay of the reverse sural artery flap, transferred from the donor to recipient site using tunneling, has, in our experience, been useful and safe, although 1 patient 10% experienced partial flap necrosis and 2 20% experienced venous congestion that responded to supportive therapy. The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. Cureus effectiveness of reverse sural artery flap in the. The medial and lateral sural arteries arise from the popliteal artery superior to. Medial sural artery perforator flap plastic surgery key. Pdf reverseflow medial sural artery perforator flap.
Reverse sural artery flap for the reconstruction of. Various modifications of the flap technique have been described in various studies. From january 2011 to december 2014, 21 patients of soft tissue defect involving lower third. This flap is based on perforators of the peroneal artery system. The large reverse sural flap from the proximal and middle third of the leg was performed on the large defects more than 12 cm in. Reverse sural artery flap request pdf researchgate. Reverse sural artery adipofascial turndown flap for ulcerations with achilles exposure by david pougatsch, dpm and karen shum, dpm wound management continued on page the reverse sural artery flap is typically performed as a distally based fasciocutaneous flap. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied.
The distally based sural artery flap, which is perfused by reverse flow through the anastomosis between the superficial sural artery and the lowermost perforator of the peroneal artery, forms part of this group. Free flap is ideal for these defects and gives good results but with its own limitations. An defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. The versatile reverse flow sural artery neurocutaneous. Role of reversed sural artery flap in reconstruction of lower. Jan 17, 2016 a pedicled flap for lower limb defect coverage. Various modifications of the flap technique have been described in. Nevertheless, it is a demanding microsurgical operation that requires knowledge of the anatomy and surgeons experience. In the present report, we describe the use of the delayed sural artery flap, combined with tissue expansion, for coverage of distal leg, ankle, and hindfoot wounds, in a series of 10 patients. Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. The reverse sural fasciocutaneous flap offers the surgeon a straightforward procedure that minimizes donorsite morbidity and preserves the major.
Reverse sural flap for ankle and heel soft tissues reconstruction ncbi. A reverse superficial sural artery flap rssaf raised as an adipofascial flap was used for coverage of the wound. Reverse sural fascio cutaneous flap for soft tissue. Clinical study comparison between peroneus brevis flap and. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Sural artery flap remains a viable option for the reconstruction of soft tissue defects of the distal third of the leg and. Reverse flow superficial sural artery fasciocutaneous flap. Is it safe to extract the reverse sural artery flap from the. Caveats for success complex open wounds of the distal third of the leg and ankle remain a reconstructive challenge for the plastic surgeon.
Pdf the reverse superficial sural artery flap revisited. Partial flap loss was found in 2 patients 8%, marginal flap necrosis in 2 patients 8% and complete loss in 1 patient 4%. Case 2 a 28yearold patient had a severe ankle contracture from burn injury in childhood. View enhanced pdf access article on wiley online library html view. Success of reverse suralfasciocutaneous flap for coverage. Pdf clinical study comparison between peroneus brevis flap. We did a retrospective study on 64 patients admitted between 2011 and 20 with posttraumatic moderate size defects of lower onethird leg who underwent rsafs and dpbfs. Reverse sural artery flap has proved to be a good option to reconstruct soft tissue defects of lower limb and foot region. Since the introduction of this flap by masquelet in 1992, it has become one of the favourite among reconstructive surgeons. Single patient with a full thickness soft tissue loss over the posterior calcaneal tuberosity requiring soft tissue coverage. One of the major challenging problems, facing the reconstructive. The reverse sural artery flap is a reliable alternative for wound coverage at the ankle and foot, with low complication and morbidity rate. Once this pivot point is determined, the length of.
Donski and fogdestam, in 1983 described the flap and later by the year. Caveats for successful performance of the reverse sural artery flap. The success of the reverse sural flap is predicated on the ability to correctly incorporate its vascular supply which is based off the sural nerve and, to a greater extent, the sural. Reverse sural artery flap christopher finkemeier, md 4 years ago video shows the technique for a reverse sural artery flap used to cover a full thickness skin loss over the calcaneal tuberosity from delay in treatment of a severely displaced tongue type calcaneus fx. The reverse sural artery pedicle flap is based off of a consistent perforating artery from the peroneal vessels. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. Role of reversed sural artery flap in reconstruction of. Reverse sural artery adipofascial turndown flap for. Pdf the reverse superficial sural artery flap revisited for. The reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is increasingly being used for coverage of defects that involve the distal third of the leg, ankle, and foot.
The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among surgeons. This kind of injury commonly occurs when lower limbs get stuck in between the spokes of the wheel. Infected lateral malleolar bursitis occurring as a diabetic complication requires debridement and flap surgery because it cannot be treated by conservative methods. The main perforators of the medial sural artery are located on a line drawn from the midpoint of the popliteal. Video shows the technique for a reverse sural artery flap used to cover a full thickness skin loss over the calcaneal tuberosity from delay in treatment of a severely. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the. Using an audible doppler probe to locate a distal perforator over the medial calf, a template of the defect was then centered about this point to create a 6. Jun, 2016 the distally based sural artery flap, which is perfused by reverse flow through the anastomosis between the superficial sural artery and the lowermost perforator of the peroneal artery, forms part of this group.
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