SLR - February 2020 - Joseph R. Fleck

Reverse Sural Artery Flap: A Reliable Alternative for Foot And Ankle Soft Tissue Reconstruction

Reference: Korompilias A, Gkiatas I, Korompilia M, Kosmas D, Kostas-Agnantis I. Reverse Sural Artery Flap: A Reliable Alternative for Foot And Ankle Soft Tissue Reconstruction. European Journal of Orthopaedic Surgery & Traumatology. 2018 Oct 29;29(2):367-372

Scientific Literature Review

Reviewed By: Joseph R. Fleck, DPM
Residency Program: Saint Francis Hospital & Medical Center – Hartford, CT

Podiatric Relevance: The reverse sural artery flap provides the surgeon a thin fasciocutaneous flap that allows for skin coverage with ideal contouring without sacrificing any major vessels in a one stage procedure. The flap has been used successfully in soft tissue defects, including the inferior and posterior heel, Achilles tendon, middle and distal one-third of the leg, dorsum of the ankle and lateral and medial malleolus.

Methods: A level IV retrospective study was performed on ten patients who underwent a reverse sural flap for a soft tissue deficit in the foot and ankle. All operations were performed by the same team and each patient followed the same post-operative plan. Demographic data was gathered as well as original deficit size and possible complications from the defect and donor site. The minimal follow up was 18 months.

Results: The mean age of the ten patients was 40.5 years (ranging 17-72) with nine patients being male. Seven of the cases were due to trauma, two to osteomyelitis, and one to a dog bite. Four patients had defects on the posterior heel, three on the medial malleolus, two on the dorsal ankle and one on the plantar foot and posterior aspect of the heel. Seven patients were smokers and five were diabetic. Nine of the flaps survived without further soft tissue defect. There was one case of complete necrosis six weeks post-operatively that eventually healed with debridement and application of a free fasciocutaneous anterolateral thigh flap. All donor sites healed uneventfully with no evidence of recurrence. At the last follow up, all patients were able to ambulate and stated they were satisfied with the result.

Conclusions: This study presented 90 percent survivorship of the sural flap in a population of patients with 70 percent trauma, 70 percent smokers and 50 percent diabetics. All patients were able to ambulate at their last follow up and were satisfied with their end result. The reverse sural artery flap is a viable choice for patients with certain soft tissue defects of the foot and ankle.

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