Reverse Sural Adipofascial Flaps with Acellular Dermal Matrix and Negative-Pressure Wound Therapy
Matthew E Pontell1, Noah Saad, Brian S Winters
1Matthew E. Pontell, MD, is a Resident, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania. Noah Saad, MD, is a Resident, Department of Surgery, University of Maryland, Baltimore, Maryland. Brian S. Winters, MD, is an Orthopedic Surgeon, Rothman Institute, Egg Harbor Township, New Jersey, and Assistant Professor of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania. Joseph N. Daniel, DO, is an Orthopedic Foot/Ankle Surgeon, The Rothman Institute of Orthopedics, Egg Harbor Township, New Jersey, and Residency Program Director, Rowan University School of Medicine, Stratford, New Jersey. Adam Saad, MD, is a Plastic Surgeon, the Plastic Surgery Center, Institute for Advanced Reconstruction, Egg Harbor Township, New Jersey, and Assistant Professor, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Abstract:
The reverse sural adipofascial flap (RSAF) is used to reconstruct challenging wounds of the foot and ankle. It offers several advantages over the traditional reverse sural flap, including less venous congestion. To complete the reconstruction, split-thickness skin grafting (STSG) may be done immediately or in a delayed fashion; however, both scenarios result in suboptimal take rates and prolonged healing. An acellular dermal matrix (ADM; Integra; Ethicon Inc, Somerville, New Jersey) and negative-pressure wound therapy (NPWT) combined with RSAF followed by delayed STSG may decrease wound healing time.In this study, 8 patients underwent reconstruction of lower-extremity wounds with RSAF. Four patients underwent RSAF with immediate STSG, and 4 underwent RSAF with placement of the ADM and a vacuum-assisted closure device, with STSG at a later date.The 4 patients who underwent RSAF and immediate STSG had an average time to heal of 141.2 days, and 2 patients required reoperation. The 4 patients who underwent RSAF with an ADM and NPWT had an average time to heal of 104.5 days, and 1 patient required reoperation. Average time until STSG was 41.5 days. The latter group demonstrated a reduction in time to heal by an average of 36.7 days, or 25%. All 8 patients achieved successful wound closure.The RSAF is a durable option for complex lower-extremity reconstruction. Interim placement of ADM and NPWT may increase STSG take rates. Using this technique in conjunction with RSAF may decrease the overall healing time compared with RSAF with immediate STSG.
