Lower-limb reconstruction utilizing the reverse sural artery flap-gastrocnemius muscle cuff technique

The reverse sural artery flap was described in 1992 and has become an acceptable technique of lower-limb reconstruction. In 2001, Al-Qattan introduced the concept of raising the reverse sural artery flap with a gastrocnemius muscle cuff for lower limb reconstruction and used it in 9 cases and noted a dramatic reduction in the ischemic events with this distally based flap technique. In the current paper, 30 consecutive patients with lower-limb defects were operated upon between 2001 and 2004. All patients underwent reconstruction utilizing Al-Qattan's reverse sural artery flap-gastrocnemius muscle cuff technique. The defects were classified into 4 types: open lower and midtibial fractures (n = 9), Achilles tendon defects (n = 6), heel defects exposing the calcaneus (n = 7), and complex ankle and foot defects exposing bone (n = 8). No cases of major vascular compromise were noted. Two diabetic patients had minor complications in the flap: one patient developed mild venous congestion and epidermolysis limited to the distal edge of the flap, and the second patient had a minor delayed wound healing at the most distal part of the flap. Both patients did not require further surgery. No cases of infection, hematoma, or painful neuroma were noted. After a mean follow-up period of 2 years (range 1-4 years), all flaps remained stable and all Achilles tendon repairs remained intact. The results of this series compares favorably with the results of other series in the literature, indicating the versatility and the better blood supply of the reverse sural artery flap when raised with a gastrocnemius muscle cuff. Other technical tips to ensure a successful outcome are also discussed.