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Reverse sural flap for ankle and heel soft tissues reconstruction.

R N Ciofu1, D G Zamfirescu2, S A Popescu3

  • 1"Sf. Maria" Hospital, Bucharest, Romania.

Journal of Medicine and Life
|March 4, 2017
PubMed
Summary

The reverse sural flap effectively reconstructs ankle and heel soft tissue defects, offering a valuable alternative to microsurgical free transfers. While generally safe, it

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • The sural flap, originating from the medial calf, has evolved as a versatile reconstructive option for lower extremity soft tissue defects.
  • Historically, its use has expanded from fasciocutaneous to perforator-based flaps, demonstrating utility from the knee to the heel.
  • The reverse sural flap is particularly noted for its application in distal leg, ankle, and heel reconstructions.

Purpose of the Study:

  • To evaluate the efficacy and safety of the reverse sural flap for soft tissue reconstruction in the ankle and heel.
  • To assess the flap's viability as an alternative to microsurgical free transfer in specific patient populations.
  • To report complication rates and functional/aesthetic outcomes in patients undergoing reverse sural flap reconstruction.
Keywords:
ankleheelreverse sural flapsoft tissues reconstruction

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Main Methods:

  • A cohort of 10 patients with ankle or heel soft tissue defects underwent reverse sural flap reconstruction.
  • Indications for reconstruction included cancer excision, trauma, unstable scars, and chronic osteomyelitis.
  • Microsurgical free transfer was considered contraindicated or not desired by the patients.

Main Results:

  • All 10 defects were successfully covered with reverse sural flaps, achieving good functional and acceptable aesthetic outcomes.
  • A 30% complication rate was observed in a high-risk patient group, including minor flap tip loss and transient venous congestion.
  • Secondary healing was effective for minor tip necrosis, and venous congestion resolved within days.

Conclusions:

  • The reverse sural flap is a valuable reconstructive option for ankle and heel defects, especially when microsurgical free transfer is not feasible.
  • It is not recommended for patients with significant venous stasis due to the risk of flap congestion and loss.
  • The reverse sural island flap should be considered an equally valuable alternative to free tissue transfer for small to midsized defects.