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The modified reverse sural artery flap lower extremity reconstruction.

Mark P Foran1, Jeff Schreiber, Michael R Christy

  • 1Division of Plastic Surgery, Johns Hopkins Hospital; and the Division of Plastic Surgery, University of Maryland, Baltimore, Maryland, USA.

The Journal of Trauma
|January 12, 2008
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Summary

Delaying reverse sural artery flaps and using a wider pedicle significantly reduces necrosis in lower extremity wound repair. This modified technique improves outcomes for patients with critical tissue defects.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Reverse sural artery flap is an alternative to free tissue transfer for distal leg and ankle defects.
  • The original technique has a notable risk of flap necrosis (up to 25%).
  • Hypothesis: Flap delay and increased pedicle width reduce necrosis.

Purpose of the Study:

  • To evaluate the efficacy of a delayed reverse sural artery flap with a 4-cm pedicle.
  • To reduce partial flap necrosis in distal lower extremity reconstructions.

Main Methods:

  • Five patients with distal lower extremity open wounds underwent the procedure.
  • Fasciocutaneous reverse sural artery flaps were elevated on a 4-cm wide pedicle.
  • A surgical delay ranging from 48 hours to 2 weeks was employed.

Main Results:

  • All five patients (22-75 years old) had trauma-related ankle defects.
  • Successful wound healing was achieved in all cases.
  • No flap necrosis was observed, with favorable functional and aesthetic outcomes.

Conclusions:

  • A surgical delay of 1 week and a 4-cm pedicle may enhance flap survival.
  • This modification potentially increases the arterial network, reducing necrosis.
  • The technique shows promise for patients with vasculopathy and critical defects.