Reverse sural flap for ankle and heel soft tissues reconstruction

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.

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.