Sural Artery as a Recipient Vessel for Free Flaps

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Trauma Management

Background:

• Axial vessels (e.g., tibial arteries) are primary choices for lower limb free flaps.
• Proximal leg defects present challenges due to the deep course of axial vessels.
• Alternative recipient vessels exist but may be less accessible for proximal defects.

Purpose of the Study:

• To define indications and techniques for using sural vessels as recipient pedicles.
• To evaluate the efficacy of sural vessels for proximal and middle third leg defects.

Main Methods:

• Retrospective review of 18 patients (2006-2022) with leg defects.
• Latissimus dorsi muscle flaps utilized, with sural vessels as recipient pedicles.
• Analysis of defect location, flap success, and complications.

Main Results:

• 18 leg defects (proximal, middle, or combined thirds) were treated.
• 16 out of 18 flaps (88.9%) achieved successful wound coverage.
• Complications included two arterial thromboses and one venous thrombosis requiring re-exploration.

Conclusions:

• Sural vessels are an accessible and reliable recipient pedicle for free flaps in proximal and middle third leg defects.
• Utilizing the submuscular course of sural vessels enhances distal flap reach.
• This technique provides a valuable alternative for complex lower limb reconstructions.