Distally based sural flap for ankle and foot coverage in children

Area of Science:

• Plastic Surgery
• Pediatric Orthopedics
• Reconstructive Surgery

Background:

• Soft-tissue defects of the ankle and foot present significant reconstruction challenges.
• The distally based sural fascio-cutaneous flap is a versatile option for lower extremity reconstruction but has limited evaluation in pediatric patients.

Purpose of the Study:

• To assess the reliability of the distally based sural fascio-cutaneous flap in pediatric patients.
• To document complications associated with its use in this population.
• To define optimal indications for this flap in pediatric ankle and foot reconstructions.

Main Methods:

• A retrospective case-series study evaluated 20 pediatric patients (ages 1.5-17 years) undergoing reconstruction with a distally based sural fascio-cutaneous flap.
• Follow-up included physical examination and the modified Kitaoka score, with a mean follow-up of 50.6 months.

Main Results:

• Flap viability was high, with 80% fully viable and 20% experiencing partial necrosis requiring secondary skin grafting.
• Functional outcomes were generally good, with 90% of patients achieving excellent or good modified Kitaoka scores.
• Complications included marginal necrosis, donor-site scarring, and abnormal flap sensation.

Conclusions:

• The distally based sural fascio-cutaneous flap is a reliable and effective method for covering pediatric ankle and foot soft-tissue defects.
• It is particularly indicated for acute traumatic defects with exposed vital structures.
• Caution is advised for late reconstructions due to potential delayed complications, especially at the donor site.