Increasing versatility of the distally based sural flap.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Orthopedic Surgery

Background:

• Repairing distal lower limb soft tissue defects presents significant challenges.
• Existing reconstructive procedures often lack efficiency and have high morbidity.
• The distally based sural flap is increasingly utilized, but its optimal skin paddle limits are debated.

Purpose of the Study:

• To evaluate the reliability of extending the distally based sural flap donor area to the proximal calf.
• To assess the efficacy of including mesenteric tissue for enhanced flap irrigation.
• To investigate the impact of avoiding a subcutaneous tunnel on flap viability and venous congestion.

Main Methods:

• A series of 11 patients undergoing reconstructive surgery using distally based sural flaps were analyzed.
• In 6 patients, the flap skin paddle was extended to the proximal calf region.
• Whole mesenteric tissue under the deep fascia was incorporated to improve irrigation.
• Flap pedicles were not passed through subcutaneous tunnels to mitigate venous congestion risks.

Main Results:

• All 11 flaps survived completely without signs of venous congestion.
• Extending the flap to the proximal calf proved to be a reliable maneuver.
• Avoiding the subcutaneous tunnel appeared to reduce the risk of venous congestion.

Conclusions:

• Extending the distally based sural flap donor area to the upper leg is a reliable technique for treating distal lower limb and foot defects.
• Omitting the subcutaneous tunnel for the flap pedicle may decrease the risk of venous congestion, enhancing surgical outcomes.