Sshaped reverse sural flap for reconstruction of tissue defect on. Utility of proximally based sural fasciocutaneous flap for. In particular, guidelines for pedicled flap surgery in hemophilia b patients have still not been defined. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein grafts are rarely needed to. The result after performing surgery flap was viable without any complication.
The distal part of the exposed bone was covered with the reverse sural artery flap without loss of sensation at anytime to the lateral part of the foot. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. Alt flap and reverse sural flap for simultaneous soft. Jan 12, 2011 the lateral supramalleolar skin flap offers a range of coverage similar to that of the sural flap, but the dissection is more difficult than for a sural flap and offers no advantages, the remaining nonsensitive area in sural flaps is smaller than the one left after the transection of the superficial peroneal nerve. A comparison of fasciocutaneous and adipofascial methods. The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer for coverage in the foot and ankle area. It is located between the popliteal fossa and the midposterior leg between the medial and lateral heads of the gastrocnemius muscle. A new modification increasing the reliability of the flap. The success of the reverse sural flap is predicated on the ability to correctly incorporate its vascular supply which is based off the sural nerve and, to a greater extent, the sural artery which provides the true vascular. Distallybased sural flap nattakul yamprasert, md department of orthopaedics, maharat nakhon ratchasima hospital regional hand meeting 2015 the diversity of the hand and upper extremity surgery august 20th 21st, 2015 at ubon ratchathani, thailand 2.
The sural flap is frequently used in the repair of a number of skin defects on the ankles, although reports on the use of this flap in pes equinovarus surgery are scarce. Reverseflow islanded sural flap can be used for reconstructiing a large area, e. View and download sure flap microchip cat flap instruction manual online. Apr 02, 2016 the design of the desired flap is centered around the most distal perforator found to ensure the longest possible pedicle fig. Jun 05, 2014 almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. A case of heel reconstruction with a reverse sural artery. The clinical outcome of perforator based sural artery and propeller. The aim of this study is to analyze the demographic. Reverse sural artery flap has been proven to be an effective option to cover such defects. A tear dropshaped, fasciocutaneous reverse sural artery flap was elevated b and a fasciocutaneous reverse sural artery flap was performed c.
Hallock gg 2014 medial sural artery perforator free flap. This study investigates complication rates and longterm. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. The medial sural artery perforator msap free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The sural flap procedure is a versatile technique that can be used to cover many. We believe that it plays a limited role in improving the reliability of a distally based sural neurocutaneous flap and its venous return by increasing the width of the fascial pedicle. Rbcp reverse sural flap of the fasciosubcutaneous pedicle. Comparison between peroneus brevis flap and reverse sural. The reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is increasingly being used for coverage of defects that involve the distal third of the leg, ankle, and foot. The aim of this study was to evaluate the functional outcome and its usefulness over conventional distal sural artery flap or other local options available. Modified distally based peroneal artery perforator flap. The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. The authors treated 33 patients for small and mediumsize defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers.
Distally based sural flap for ankle and foot coverage in. Cheon et al 28 and suri et al 29 reported that proximally based fasciocutaneous sural artery flap is useful for reconstruction of softtissue defects around the knee and on the proximal and medial third of the leg. In this report of 6 patients underwent surgical reconstruction by this. The sural flap is a fasciocutaneous adipofascial flap based on a distal pedicle, used frequently for covering defects located in the middle to distal third of the calf, ankle and leg. The reverse sural nerve flap is one of many versatile neurofasciocutaneous techniques available for staged reconstruction of lower limb and foot. Distally based sural flap for ankle and foot coverage in children. Surgical anatomy of the medial sural artery perforator flap. Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. Coverage of softtissue defects of the ankle and foot is often challenging. Distally based reverse sural artery flap as an interpolation flap.
Sshaped reverse sural flap is a modified technique of reconstruction. Based sural artery and propeller flaps in reconstruction of soft tissue. The small saphenous vein was included to make the venous return easier. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. Free flap is ideal for these defects and gives good results but with its own limitations. To overcome this, we have modified our operative technique, which has produced a more reliable flap. The modifications combine the advantages of the sural neurofasciocutaneous flap and the perforatorbased flap and overcome their shortcomings. The most common usage of the flap is for the distalthird defects of the leg.
Increasing the success of reverse sural flap from proximal. Sshaped reverse sural flap for reconstruction of tissue defect on heel. Defects at this site will often require flap cover. Zhang cp, zhang yx 2014 a prospective study of medial sural artery perforator flap with computed tomographic angiographyaided design. There have been few reports regarding the use of proximally based sural artery flap. In all cases, the flap was cut in its fasciocutaneous variant. This is a case series of 20 patients that include a dbspf that was done for defects around ankle, distal leg, and foot caused by. This flap is designed on the proximal third of the posterior. The medial sural artery perforator msap flap shows advantages for reconstruction in the foot and ankle, where bulk is a liability. The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among. The reverse superficial sural artery flap revisited for. The technique is based on the use of a reverseflow island sural flap combined with.
May 05, 2014 this study evaluates the clinical outcomes of using a proximally based sural fasciocutaneous island flap for reconstruction of traumatic softtissue defects around the knee and on the proximal lower leg. The reverse superficial sural artery flap rssaf is a popular option. To solve this issue, we propose a distally based sural artery peroneus flap dbspf in which we include superficial portion of the peroneus brevis muscle and its. The sural artery flap is a type a fasciocutaneous flap based on the sural artery direct cutaneous branch of the popliteal artery. Distally based sural flap is widely used, however it leaves donor area paresthesia. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at. Distally based sural artery peroneus flap dbspf for foot. Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. Twenty patients comprising of males and 7 females with soft tissue defects.
Technical details of using sural flap in pes equinovarus surgery. Distally based sural neurofasciocutaneous perforator flap. Pdf 9 academic content and language evaluation of this article. Cureus effectiveness of reverse sural artery flap in the. The reverse superficial sural artery flap revisited for comp. We applied open tunneling technique for sural flaps. To solve this issue, we propose a distally based sural artery peroneus flap dbspf in which we include superficial portion of the peroneus brevis muscle and its blood. May 24, 2015 kao hk, chang kp, chen ya, wei fc, cheng mh 2010 anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. The medial sural artery perforator msap flap is based on musculocutaneous perforators of the medial gastrocnemius muscle. A proximally based sural fasciocutaneous flap for the. The reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel. Pdf the reverse sural fasciocutaneous flap for the treatment of. A fasciocutaneous flap with a pedicle preserving its blood and nerve supply was created. We combined method the tumor excision for malignant melanoma and performed sural flap to closure the soft tissue defect after performing wide excision tumor.
The authors present their experience with the sural flap, also in some particular cases. Sural flap is fasciocutaneous flap, made up of skin, subcutaneous fat, superficial and deep fascia of the posterior part of the lower leg, sural nerve, sural vein, and superficial sural artery. Medial sural artery perforator flap plastic surgery key. We evaluated the versatility of this flap and provide further evidence on its use for covering small. Soft tissue reconstruction of foot and ankle defects with reverse sural. It is a versatile and reliable technique for softtissue reconstruction of the heel and ankle region with 180degrees rotation. To overcome this problem, we describe an interpolation flap technique in which subcutaneous tunnelling of. In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. Sural flap use for the treatment of wounds with underlying. The design of the desired flap is centered around the most distal perforator found to ensure the longest possible pedicle fig. Pdf reverse sural flap for ankle and heel soft tissues reconstruction.
Furthermore, the sacrifice of the sural nerve results in hyposensitivity of the lateral border of the foot. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Partial flap loss was found in 2 patients 8%, marginal flap necrosis in 2 patients 8% and complete loss in 1 patient 4%. The distally based sural fasciocutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. At 1year postoperation, the patient could walk a long distance without a crutch. Distally based fasciocutaneous sural flap for foot. We want to recommend sural flap rahadyan magetsari 1, yudha mathan sakti, arie nugroho 2. The sural flap proved a considerable versatility at the level of the lower leg from the knee to the ankle and heel as well as for other anatomical regions.
Perforatorplus fasciocutaneous flap harvest from the posteromedial sural region. The understanding of the skins vascular anatomy has improved in the last decade. Objective soft tissue injuries at the level of lower extremities, plantar, and dorsal foot pose a surgical challenge for reconstructive surgeons. Harvest of distally based fasciocutaneous island flap from the lateral sural region with a wide adipofascial pedicle. A 57yearold male patient presented with a soft tissue defect and infection on the right lateral malleolar area of the ankle joint a. The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among surgeons. The flap consists of superficial and deep fascia, the sural. Distally based perforator sural flaps for foot and ankle reconstruction. The management of soft tissue defects of the lower extremity with underlying osteomyelitis is difficult. Medial sural artery perforator free flap msap british. Versatility of delayed reverseflow islanded sural flap for. Sep 22, 2015 the reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is increasingly being used for coverage of defects that involve the distal third of the leg, ankle, and foot.
The medial sural artery perforator msap flap is an increasingly versatile and reliable flap for soft tissue reconstruction. Pdf reverseflow medial sural artery perforator flap. This kind of injury commonly occurs when lower limbs get stuck in between the spokes of the wheel. The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. Pdf acute vascular complication following sural flap.
Article information, pdf download for sural flap use for the. The distally based sural artery flap for ankle and foot. Pdf distally based sural artery peroneus flap dbspf for. Considering data from previous studies and this study, the use of the reverse sural flap of the fasciosubcutaneous pedicle or reverse adipofascial flap has a good prognosis. The reverse sural fasciocutaneous flap for the treatment of. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot.
This is a case series of 20 patients that include a dbspf that was done for defects around ankle, distal leg, and foot. Patients were positioned prone or lateral and a tourniquet was. A reverse sural artery flap was raised without transecting the sural nerve to cover the distal part of the defect. The patient selection and surgical refinement are discussed. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. A pragmatic evaluation of the role of the medial sural. Reconstruction of the foot and lower leg defects by. The radiating pain was significantly reduced at 1month postoperation. At this point, the island flap including the skin, subcutaneous tissue, and the deep fascial tissues containing the neurovascular structures. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. Distallybased sural flap nattakul yamprasert, md department of orthopaedics, maharat. Surgical anatomy of the medial sural artery perforator flap wong et al.
A pragmatic evaluation of the role of the medial sural artery. Pdf the distally based sural fasciocutaneous flap has become a main part of the. The potential of the medial calf integument, as donor site for a free flap based on. Versatility of delayed reverseflow islanded sural flap. The vascular pedicle included 23 cm wide fasciae, the sural nerve, and the accompanying sural artery. The management of softtissue defects in the ankle and foot area is a challenging task.
The reverse superficial sural artery flap revisited for complex. This flap is based on perforators of the peroneal artery system. Proximally based sural adiposecutaneousscar flap in. The main perforators of the medial sural artery are located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. Reverse sural flap for ankle and heel soft tissues. Reverse sural artery flap request pdf researchgate. Distally based perforator sural flaps for foot and ankle. The distally based sural fasciomusculocutaneous flap for. Pdf distally based sural artery peroneus flap dbspf. A perforator within this region is routinely present. The reverse superficial sural artery flap rssaf is a popular option for many of these difficult wounds. The sural artery flap is insensate and is not an option in cases in which sensitivity is an issue. The distally based superficial sural flap for reconstruction of the.
Wrapping the released common peroneal nerve with a proximally based sural fasciocutaneous flap is a useful option for the treatment of recurrent, common peroneal neuropathy. Download as an information leaflet pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. The flap consists of superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery. There was no complete flap loss in any of the patients. A total of 71 patients were operated on with this technique, some of them with basic pathologic abnormalities limiting the distal blood flow, such as diabetes. The reverse sural artery flap for the reconstruction of. Sural flap can become the answered and alternative solution to closure defect in the calcaneal region.
The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have. Almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. Microchip cat flap pet care product pdf manual download. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein grafts are rarely needed to reach a recipient site.
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