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Related Experiment Video

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Clinical and Functional Outcomes Following Reverse Sural Flap of Lower Extremity Defects: A Comparative Retrospective

Saleh Abualhaj1,2,3, Mosleh M Abualhaj4, Lina Alshadfan5

  • 1Department of Plastic Surgery, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan.

Clinics in Orthopedic Surgery
|April 6, 2026
PubMed
Summary
This summary is machine-generated.

Reverse sural artery flap (RSAF) outcomes vary by lower extremity defect site. Patient factors like smoking and obesity are stronger predictors of complications than defect location.

Keywords:
FootLower extremityReconstructive surgical proceduresSoft tissue injuriesSurgical flaps

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Area of Science:

  • Orthopedic Surgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • The reverse sural artery flap (RSAF) is a common technique for soft-tissue reconstruction in the lower extremities.
  • Outcomes of RSAF can be influenced by the specific location of the defect, such as the ankle, heel, or lower leg.
  • Identifying factors that predict complications is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare clinical, functional, and aesthetic outcomes of RSAF across different lower extremity defect sites (ankle, heel, lower leg).
  • To identify independent predictors of postoperative complications following RSAF.
  • To evaluate the impact of defect location versus patient-specific factors on RSAF success.

Main Methods:

  • Retrospective analysis of 60 patients undergoing RSAF for lower extremity soft-tissue defects.
  • Stratification of patients based on defect location: ankle, heel, or lower leg.
  • Analysis of clinical data, complication rates, functional outcomes (using Foot and Ankle Ability Measure [FAAM]), and aesthetic outcomes (using Vancouver Scar Scale).

Main Results:

  • The heel group had the highest complication rate (50%) and poorest functional outcomes (mean FAAM score 76.8).
  • The lower leg group demonstrated the best functional outcomes (mean FAAM score 91.2) with a lower complication rate (6.2%).
  • Multivariable analysis identified smoking, elevated BMI, and longer pedicle length as independent predictors of complications, with defect location not reaching statistical significance.

Conclusions:

  • While heel defects showed higher raw complication rates, patient factors (smoking, obesity, pedicle length) are more significant independent predictors of adverse outcomes.
  • Preoperative optimization and careful patient selection are essential for improving RSAF results.
  • The influence of heel location on outcomes should be interpreted cautiously due to potential confounding factors, including smoking prevalence in this subgroup.