Reverse sural artery flap for distal lower extremity defects

Traumatic and various dermatological conditions resulting in skin and subcutaneous tissue loss on the lower limb cause a therapeutic challenge for the dermatological surgeon, because this anatomical location lacks adequate skin laxity and has limited local soft tissue, especially around the heel. In this report, we present our experience with the reverse sural artery flap on seven patients. The soft tissue defect was traumatic in two patients. We also treated three diabetic patients. There were no immediate or late surgical complications in four cases; flap and donor site healing was uneventful. The remaining three cases were diabetic, and all presented with the following complications: rejection of split skin graft at donor site, infection at the flap border and superficial flap necrosis. The flap necrosis was concluded to be at least in part due to the patient's noncompliance with postoperative measures. We conclude that the reverse sural artery flap is a satisfactory alternative in the reconstruction of lower limb defects, but we also feel that the importance of proper evaluation prior to surgery in terms of vascular impairment and patient compliance should be emphasized to ensure a successful surgical outcome.