Enhanced survival using the distally based sural artery interpolation flap.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• The reverse sural artery flap is a common technique for reconstructing the distal leg, ankle, and heel.
• A significant disadvantage of this flap is pedicle compression within the subcutaneous tunnel, leading to venous congestion.
• Previous attempts to mitigate this issue involved modifications like including gastrocnemius muscle cuffs or widening the pedicle.

Purpose of the Study:

• To present a novel interpolation flap technique for reverse sural artery flaps.
• To eliminate the need for a subcutaneous tunnel in reverse sural artery flap elevation.
• To improve flap reliability and reduce venous congestion in distal leg, ankle, and heel reconstructions.

Main Methods:

• A two-stage reverse sural artery flap transfer was performed, exteriorizing the pedicle without a subcutaneous tunnel.
• No other alterations to standard flap design or elevation techniques were made.
• Seven such flaps were performed on ambulatory patients between 2001 and 2002.

Main Results:

• No instances of venous congestion were observed in any of the seven flaps.
• All patients remained ambulatory following surgery.
• None of the patients required custom footwear post-operatively.

Conclusions:

• Transferring the reverse sural artery flap in two stages without a subcutaneous tunnel is a reliable technique.
• This method effectively eliminates venous congestion associated with the flap.
• The technique offers an improved approach for reconstructive surgery of the distal lower extremity.