Soft tissue reconstruction of the foot with a reverse flow sural artery neurofasciocutaneous flap

Distally-based sural artery flaps are used to cover soft tissue defects of the lower leg, ankle, and heel. These flaps are vascularized by septocutaneous perforators of the peroneal artery that anastomose with the perineural and perivenous arterial networks of the sural nerve and the lesser saphenous vein, respectively. A retrospective study of seven patients with a distally-based neurofasciocutaneous sural artery flap for ankle or heel defects that had failed conservative treatment was conducted from 1999 to 2003. The presence of a patent peroneal artery was a requirement for this operation. Among the seven patients, the only flap failure occurred in a renal transplant patient who was immunocompromised. The other six patients healed uneventfully and resumed full weight-bearing status. The mean time to return to shoe was 90.2 days. The average healing time of all seven patients was 3.3 months. Based on these results and other documented successes, the procedure can be considered a viable treatment alternative.