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The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction
Kristoffer B Sugg1, Timothy A Schaub1, Matthew J Concannon1
1Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.; Department of Orthopaedic Surgery St. Joseph's Hospital and Medical Center, Phoenix, Ariz.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Concannon Plastic Surgery, Columbia, Mo.
Modifying the reverse superficial sural artery flap (RSSAF) technique by increasing pedicle width to at least 4 cm significantly improved limb salvage rates. This modification reduced critical venous congestion, enhancing flap reliability for distal lower extremity reconstruction.
Area of Science:
- Plastic Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Distal lower extremity and foot soft-tissue defects pose reconstructive challenges.
- The reverse superficial sural artery flap (RSSAF) is a common but historically unreliable option.
- Early RSSAF use had a 50% failure rate, primarily due to venous congestion.
Purpose of the Study:
- To evaluate the impact of a modified surgical technique on RSSAF outcomes.
- To determine if increased pedicle width improves flap survival and reduces complications.
- To compare outcomes between an early and a late group of patients undergoing RSSAF reconstruction.
Main Methods:
- Retrospective review of 27 patients undergoing RSSAF reconstruction (May 2002-September 2013).
- Comparison of an early patient group with a late group that adopted a modified technique.
- Key modification involved increasing the pedicle width to at least 4 cm.
Main Results:
- Limb salvage rate improved from 50% in the early group to 93% in the late group (P=0.02).
- Venous congestion requiring leech therapy decreased from 42% to 0% (P=0.01) in the late group.
- Postoperative complication rates were similar between groups (75% vs. 67%, P=0.70).
Conclusions:
- Venous congestion is a major factor in RSSAF failure.
- Increasing RSSAF pedicle width to at least 4 cm is crucial for venous drainage.
- This modification enhances flap viability and improves limb salvage rates.
