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Background: The coverage of the distal third of the leg and foot was still a challenge for reconstructive surgery due to its limited distensibility and mobility, low blood supply, and lack of muscle tissue interposition between noble structures and the integument. These features make randomized grafts and flaps unsuitable for wounds in this region.Aim of the work: To assess the potentiality of [two stages] versus [one stage] distally based reverse sural flap for distal third of leg and foot reconstruction.Patients and Methods: This meta-analysis included the recent updates as we retrieved 77 references to studies. After examination of the titles and abstracts of these references, we eliminated all of those which did not match our inclusion criteria and those which were clearly ineligible from the review. We obtained full text copies of the remaining seven potentially eligible trials for further evaluation.Results: Seven studies assessing rate of Partial necrosis among two groups showing that there were insignificant differences. seven studies assessing rate of complete flap necrosis among two groups showing that there were insignificant differences. seven studies assessing rate of secondary procedures among two groups showing that there were insignificant differences. three studies assessing rate of hospital-stay\days among two groups showing significant longer stay among single staged group.Conclusion: The distally based reverse sural flap is a versatile flap for the reconstruction of soft tissue defects of the lower leg and heel.

Le lambeau sural a été souvent utilisé pour la couverture des zones portantes et non portantes du pied et de la cheville. Cette étude rapporte notre expérience dans la couverture de ces pertes de substance au niveau du pied en zones portantes. C'est une étude rétro-prospective et descriptive de 70 mois. Elle comprend 16 patients présentant une perte de substance plantaire et/ou talonnière du pied couverte par un lambeau sural à pédicule distal. La technique de prélèvement décrite par Masquelet nous a servi de référence. Une majoration de la longueur du pédicule d'au moins deux centimètres lors de la dissection a permis d'éviter tout étirement ou compression pour les lésions les plus distales. L'âge moyen a été de 35 ans avec une sex-ratio de trois en faveur des hommes. Les atteintes traumatiques ont prédominé (n = 10) avec une superficie moyenne des lésions de 68,8 cm2. Les délais moyens d'appui partiel et total ont été respectivement de 1,8 et 3,6 mois. Nous avons noté un cas de nécrose du lambeau. L'évolution naturellement du lambeau s'est faite en trois étapes : régénération, kératinisation puis métaplasie malpighienne. L'appui bipodal normal et la marche stable sans anomalie de chaussage ont été notés dans 15 cas. La technique du lambeau sural à pédicule distal est accessible. Sa fiabilité en fait un choix idéal lors des pertes de substances distales de la jambe et du pied. The sural flap has often been used to cover the weight-bearing and non-weight-bearing areas of the foot and ankle. This study reports our experience in the coverage of these defects in the foot in weight-bearing areas. This is a retrospective and descriptive study of 70 months. This study includes 16 patients presenting a loss of plantar substance and/or heel of the foot covered by a sural flap with a distal pedicle. The sampling technique described by Masquelet served as our reference. An increase in the length of the pedicle of at least two centimeters during the dissection made it possible to avoid any stretching or compression for the most distal lesions. The average age was 35 years with a sex ratio of three in favor of men. Traumatic lesions predominated (n = 10) with an average area of lesions of 68.8 cm2. The average partial and total support times were 1.8 and 3.6 months respectively. We noted one case of flap necrosis. The natural evolution of the flap took place in three progressive stages: regeneration, keratinization and squamous metaplasia. Normal bipodal support and stable gait without footwear anomaly were noted in 15 cases. The distal pedicle sural flap technique is accessible. Its reliability makes it an ideal choice for distal loss of substance to the leg and foot. [ABSTRACT FROM AUTHOR]

The treatment of the Cierny–Mader (C–M) type III–IV calcaneus osteomyelitis combining with the soft-tissue defect is sophisticated and difficult. The aim of this study is to introduce the application and availability of the modified distally based sural flap with an adipofascial extension to reconstruct these defects. We retrospectively reviewed the data of 37 patients with C–M type III–IV calcaneus osteomyelitis accompanied with soft-tissue defect between December 2004 and December 2019. A modified distally based sural flap with an adipofascial extension was conducted to reconstruct the defect. The patient's demographics, duration of the diseases, etiology, reconstruction outcomes, infection control rate, recurrence rate, amputation rate, and follow-up data were collected to evaluate the effectiveness and reliability of the modification. The American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scale was applied to assess the function of the ankle and hindfoot. Thirty-four flaps survived uneventfully, 1 flap displayed marginal necrosis and 2 flaps (5.41%) developed partial necrosis. Using this modified flap alone or combining with some simple salvage methods reconstructed all of the defects successfully. The calcaneus osteomyelitis was cured successfully, and no recurrences were observed during the follow-up period. The AOFAS ankle and hindfoot scores were excellent in 27 patients and good in 8 patients. The distally based sural flap with an adipofacial extension is a simple and effective technique to reconstruct the calcaneus osteomyelitis combined with soft-tissue defect in 1 stage. Applications of the adipofacial extension to obliterate the dead space and the well-vascularized skin island to cover the defect are the guarantee of achieving good ankle and foot functions. However, this technique is not appropriate for the patients with calcaneum less than half weight-bearing area. [ABSTRACT FROM AUTHOR]

Distally based sural fasciocutaneous (DBSF) flaps are widely used for reconstructing soft tissue defects of the foot. The purpose of this paper was to compare the clinical efficacy of the use of flaps to repair defects in areas proximal and distal to the level of the tarsometatarsal joints in a relatively large number of patients and to analyze the effects of factors on the risk of developing partial necrosis of the flaps. Between April 2001 and December 2019, a total of 355 DBSF flaps were utilized to cover soft tissue defects in the foot. According to the furthest location of the defects reconstructed with the flaps, the flaps were divided into the proximal foot group (n = 260) and the distal foot group (n = 95). The partial necrosis rates, their influencing factors, and the clinical outcomes of the procedure were compared between the two groups. In the proximal foot group, the partial necrosis rate (6.2%, 16 of 260) was significantly lower than that in the distal foot group (14.7%, 14 of 95) (P <.05). The proportion of successful coverage of the defects using the flaps alone or in combination with a simple salvage treatment was comparable between the groups (P >.05). The ratio of unfavorable conditions in the distal foot group was higher than that in the proximal foot group (P <.05). DBSF flaps can be effectively utilized to repair defects in the proximal and distal areas of the foot. The use of a DBSF flap to repair defects in the proximal areas of the foot is superior to the use of DBSF flaps for repairing defects in the distal areas of the foot in terms of reliable survival of the flap. [ABSTRACT FROM AUTHOR]

Objectives: Distal lower leg wounds, regardless of cause, and acute trauma wounds, regardless of site, are difficult. Reconstruction of both situations are much more challenging. Inter polationsural flap is a good alternative for this type of reconstruction. Methods: Fourteen interpolation sural flap were harvested to reconstruct for distal leg region wounds due to acute trauma. Ten male and four female patients aged from 10 to 59 years old were included this study. Results: All flaps survived. No venous congestion and total flap necrosis was seen. There were 4 complications, and all of them were corrected with short interventions. After second stage, no complication was seen. Conclusions: I nterpolation sura l flap modif ication has many adv ant age s includi ng reliability, no venou s congestion, immediate reconstruction without a surgical team. However, it is a-two staged reconstruction and its donor site scarring can be serious. [ABSTRACT FROM AUTHOR]

Background: Soft tissue reconstruction with a reverse sural flap (RSAF) is a useful method to treat soft tissue defects around the ankle, distal tibia, and heels. Objectives: Proper education of patients undergoing this surgery is crucial for patients due to the complexity of the surgical procedure and the necessity to adhere to... [ABSTRACT FROM AUTHOR]

Background: Partial necrosis is an ongoing topic in regard to flap complications of the distally based sural (DBS) flap However, the factors influencing partial necrosis of the flap remain in debate. The aim of the present study is to further illuminate the flap-related risk factors and the effects of several technical improvements. Methods: We retrospectively reviewed the data of 429 patients who underwent 435 DBS flaps between April 2001 and December 2019. The reconstruction outcomes, flap viability-related complications, and potential risk factors were compared between the survival group and partial necrosis group, as well as between group A (the procedures performed from April 2001 to March 2010) and group B (those from April 2010 to December 2019). Results: Among the 435 flaps, 39 flaps (8.97%) exhibited partial necrosis. With the increase of the top edge of the flap, the partial necrosis rate increased significantly (P < 0.05). When the length-to-width ratio [LWR] of the flap was more than 5:1 or the total length of the flap (the length of the skin island plus the length of the adipofascial pedicle) was more than 20 cm, the partial necrosis rate increased significantly (P < 0.05). The partial necrosis rate in group B (5.86%, 15/256) was significantly lower than that in group A (13.41%, 24/179) (P = 0.007). Conclusions: The top edge of the flap is an essential indicator for predicting the prognosis of the DBS flap. When the total length of the flap is more than 20 cm or the LWR of the flap more than 5:1, the partial necrosis rate will increase significantly. Various technical modifications can lower the top edge of the flap and reduce the LWR of the flap and width of the skin island, and thus improve the flap survival effectively. [ABSTRACT FROM AUTHOR]

Abstract Background Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients (≥ 60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients. Methods Between March of 2005 and December of 2019, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥ 60 years old) and group B (ranging from 18 to 30 years old). Results The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05). Conclusions The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary.

Background: In a Guatemalan public hospital, 3710 fractures were diagnosed in 2016, of which 723 corresponded to the tibia. Of these tibial fractures, approximately 15% were exposed. Skin coverage in exposed fractures has always been a challenge for the attending physician. In the case of the lower limb, there is the option of making a sural flap. Objectives: To determine the effectiveness of the sural flaps when utilizing this technique as a treatment for exposed fractures in the lower limb in adult patients. Methods: A prospective observational descriptive study, the evaluated patients and patient files as primary and secondary sources, respectively, and control with observational variables. The sample consisted of 24 patients who got 3 follow-up appointments at 5 days, 2 weeks, and a year. Results: The results manifested effectiveness of 95.8%. The area most affected was the lateral malleolus. Additionally, comorbidities, schooling, and gender showed no influence on the effectiveness of the flap. Conclusion: The effectiveness of the sural flap technique in exposed fractures was 95.8%. Recommendations: Physicians ought to consider using the sural flap as the treatment of choice for skin coverage defects localized in the distal and middle third regardless of the leg and cause of the defect.

Abstract Background No large series have analysed distally based sural fasciocutaneous (DBSF) flaps in paediatric patients. The aims of this study were to assess the reliability and analyse the potential risk factors for these flaps and to describe complications in the donor site and the functional follow-up results. Methods Between June 2002 and November 2017, 88 DBSF flaps were used to reconstruct soft tissue defects in paediatric patients. Potential risk factors, reconstruction outcomes, and complications in the donor site of the flaps were analysed. Results Among the 88 flaps, partial necrosis developed in 8 flaps (9.1%). The partial necrosis rate was significantly higher in flaps with the top edge located in the 9th zone (26.1%), with a length-width ratio (LWR) ≥ 5:1 (28.6%), and with a dimension of the skin island ≥ 100 cm2 (22.7%). Partial necrosis did not occur in flaps with a dimension of the skin island < 80.0 cm2 or with a skin-island width < 7.0 cm. The reconstruction outcomes in most paediatric patients were evaluated as “excellent” or “good”. The incidence of obvious scarring was higher in the donor site. Conclusions Partial necrosis of DBSF flaps will significantly increase when the top edge of the flap is located in the 9th zone, when the LWR of the flap is ≥ 5:1, or when the dimension of the skin island is ≥ 100.0 cm2. Flaps with a skin-island width < 7.0 cm or with a dimension of the skin island < 80 cm2 are relatively safe and reliable.

Open fractures are orthopedic emergencies that require immediate surgical intervention in order to provide fracture stabilization and to prevent development of osteitis. We present the case of a 33-years-old patient presented in our clinic for a type IIIB neglected open fracture of the distal tibia. We used external fixation for fracture stabilization and a distal based fasciocutaneous sural flap for covering the wound. The purpose was to obtain union of the tibia and reducing the risk of infection. The results at 6 months are good, but the patient needs to be closely followed in time.

Background and objective. Background and objective. The distally based superficial sural artery flap has been used for lower limb reconstruction for long time. The blood supply for this flap has been studied for many authors. We present our casuistry showing that this flap can survive excluding the sural nerve from its composition and therefore preserve the sensitivity of the distal postero-lateral third of the leg and the lateral border of the foot, also preserving its undamaged irrigation. Methods. We have operated on 40 patients since 1998 to 2019, 35 men and 5 female, age ranged from 20 to 55 years old, using a superficial distally based sural flap, excluding the sural nerve. The pinch and the pin prick test were done in all patients. Results. In spite of excluding the sural nerve, the arterial blood supply to the flap was not compromised. There were 2 distal partial necrosis healed with flap advance and or split thickness skin graft. Edema was presented in 3 patients disappearing with limb elevation and light dressing. Cellulitis was presented in 4 patients and disappeared with antibiotics. Cutaneous sensitivity in the posterior and lateral distal third portion of the leg and in the edge of the foot was unalterable. Conclusions. In our clinical cases, the arterial blood supply to the distally based sural flap is not compromised with the exclusion of the sural nerve. The clinic and neurography show the patency of the sensation in the skin of the lateral and posterior part of the distal third of the leg and the lateral aspects of the foot. These findings allow to exclude the sural nerve from the flap insuring the blood supply and avoiding the possible pressure sores when the workers use their security shoes. [ABSTRACT FROM AUTHOR]

Background: Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients (≥ 60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients.Methods: Between March of 2005 and December of 2019, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥ 60 years old) and group B (ranging from 18 to 30 years old).Results: The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05).Conclusions: The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary. [ABSTRACT FROM AUTHOR]

Background & Aims: Distal leg, ankle and foot injuries are relatively common; and because of lack of soft tissue and poor blood supply in these areas, one of the common problems in these patients is soft tissue necrosis. Exposed orthopedic implants can be used as open reduction internal fixator (ORIF) in these regions. Methods: During 2013-2014, 14 patients (11 men and 3 women) with a mean age of 30 years were enrolled the study in the Department of Plastic and Reconstructive Surgery, Shafa Hospital, Kerman, Iran. All the patients were referred from the Department of Orthopedic Surgery because of exposed orthopedic implants. The minimum and maximum size of the defects was 3 × 5 and 11 × 15 cm, respectively. 7 defects were in distal leg, 3 in foot, 2 in ankle and 2 in distal leg and ankle together. After measuring the defect, sural flap based on sural artery and nerve was prepared and transferred with a rotation of 180 degrees to the defect site over the exposed orthopedic implants, before the separation. Results: In all 14 patients, the healing was complete. In 2 cases, we had to remove the prostheses because of infection and in 3 cases, partial necrosis was seen; and in 4 cases, a hypertrophic scar was seen in donor site and a neurosensorial deficit was seen in the sural nerve sensory areas. But in all of them, the sural flap was successful and there was no need to replace this flap to another one. Conclusion: Due to the good clinical results, sural flap can be a viable alternative to cover the exposed prostheses of distal leg, ankle and foot.

Defects of the lower limb are generally difficult to correct, especially in patients with associated pathologies, and they represent a challenge for the reconstructive surgeon. The sural flap provides considerable versatility for lower limb reconstructions, successfully covering defects located between the knee and the ankle or the heel. Most frequently, this flap is used for defects located in the middle to distal third of the lower limb. The scope of reconstructing defects from the lower limb extremities must be concentrated both on covering the defect, and on functional recovery. When use of a local flap is insufficient, free flaps must be used, as they provide a wider coverage of defect. We report the successful surgical management of a case of a lower extremity injury consisting of a tibial pilon fracture, proximal fibula and lateral malleolus fractures, and a medium-to-large defect on both sides (internal and external) of the left ankle, on a 61 year-old patient, insulin dependent diabetic, heavy smoker, and with poor hygiene. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, the distally based neurocutaneous sural flap has become the best known neurocutaneous flap of the leg. When microsurgical expertise is not available or feasible, the sural flap has become the mainstay of reconstruction for lower leg, ankle and foot defects. Matherial and method: The large series of cases published in the medical literature, innovations, technique modifications along with risk factors identification has been followed by this flap rise in popularity. 64 publications on the sural flap subject, in the international literature, were summarized in this study. The relevant anatomy reviewed in anatomical studies is presented in order to understand the circulation and tissue composition of the sural flap. The surgical technique and its various modifications are highlighted, in order to make proper indications and minimize complications. Risk factor identification is presented in order to preclude unfitted patients from this flap. Several clinical cases from the senior author are ilustrated. Conclusion: The distally based neurocutaneous sural flap offers a reliable and versatile technique, alternative to free flap transfer, for the treatment of complex lower limb defects in healthy or vascularly compromised patients. [ABSTRACT FROM AUTHOR]

The reverse sural flap has often been used for cutaneous coverage of the distal region of the leg and ankle. When the flap is performed in 2 stages, the vascular pedicle is exteriorized and later resected. Our goal was to assess the reverse sural flap performed in 2 stages regarding its viability and low morbidity along the flap-donor area. Eleven patients with cutaneous coverage loss found in the area between the distal third of the leg and ankle underwent cutaneous coverage surgery with a reverse-flow sural flap with an exteriorized pedicle, without violation of the skin between the base of the flap pedicle to the margin of the wound. After a minimum period of 15 days with flap autonomy, the pedicle was resected. The flap dimensions, its viability before and after the pedicle ligature, and the distance from the intact skin between the flap base and the margin of the wound were evaluated. Any losses were measured as a percentage of the total flap size. The respective length and width of the flap were a mean average of 7.45 cm × 4.18 cm. All the flaps survived. Partial loss of the flap occurred in 3 patients, ranging from 20% to 30%. The mean average distance of the intact skin between the pedicle base and the margin of the wound was 5.59 (range 4 to 8) cm. Our results showed that the 2-stage reverse sural flap ensures good flap survival and low morbidity. [ABSTRACT FROM AUTHOR]

Abstract Background Melanoma resection creates important soft tissues defects, which are difficult to manage when located on the weight-bearing heel and mid foot. There is little evidence on the use of the reverse-flow sural flap for this type of reconstruction. Objective This study reports our case series on the reconstructive management of the hind and mid-foot defects after melanoma resection using the reverse sural artery flap. Materials and Methods This is a retrospective study of four consecutive patients treated with resection of melanoma of the feet and reconstruction with reverse sural artery flap from 2006 to 2009. Results The mean age of the patients was 54 years, three were females, and one was male. Three of the defects were located on the weight-bearing heel, the other on the mid-foot dorsum. The melanomas were fully resected with wide margins. Three patients were reconstructed primarily, whereas one patient was reconstructed 4 weeks after the resective surgery. This series revealed 100% flap survival and there was no partial necrosis. Major complications were not observed. The four patients completely recovered the function of the affected limb. Conclusion The reverse sural flap is a viable option for the reconstruction of foot defects after melanoma resection.

Background and Objective. The reverse flow sural flap has won great popularity, but some authors report frequent complications of total or partial flap necrosis. We present a number of technical modifications to increase the viability of the flap when it is necessary to design it to its fullest extent to cover large defects in the foot. Methods. From August 2005 to August 2013, 4 patients underwent the procedure of reverse flow sural flap mega-high flap for foot reconstruction. The flaps ranged from 7 x 17 cm to 15 x 22 cm in size. The average follow-up was 60 months. The 3 modifications that we usually perform when making this flap are: 1.- The deep fascia is incised and lifted 1.5 cm broader than the skin island. 2.- We keep the width of the adipofascial pedicle as wide as possible. 3.- We habitually suture later on after the first procedure the flap, allowing the edema to expand. Results. No partial or total necrosis was neither observed, nor other postoperative complications. All the flaps allowed the reconstruction of the defects, without needing other complementary flaps. Conclusions. We believe that the extent of the defects and their successful reconstruction with this type of megaflap, in which we have applied the changes described, justifies the presentation of our experience. However, we note that the 4 patients had no vascular risk conditions, in which it would be advisable to delay the flap or select other reconstructive techniques. [ABSTRACT FROM AUTHOR]

Introduction: Reverse sural artery flap has been used effectively to cover defects of distal leg, ankle and foot. This flap is easier and quick to harvest and is a versatile flap in terms of extensive mobility and reliable vascularity and, in many instances it has obviated the need for free tissue transfer. Methods: This is a retrospective study of sural flaps done at the Department of Plastic Surgery' and Burns in Tribhuvan University Teaching Hospital over a period of 4 years from April 2011 to March 2015. It included 21 flaps carried out in 21 patients with soft tissue defects at distal lower leg, ankle and foot. Results: Among 21 patients, 10 were men and 11 were women with an average age of 41 years (17 - 81). Successful flap coverage was obtained in 16 cases out of 21 (76%) which included 10 cases of complete survival (48%) and 6 cases (28%) of marginal flap necrosis. Four cases (19%) had partial flap loss and one case (5%) lost flap completely. Conclusion: we found that reverse sural artery' flap has good reliability with low incidence of complications and is a versatile flap for the reconstruction of defects in distal leg, ankle and foot. [ABSTRACT FROM AUTHOR]

Background The use of distally based neurocutaneous sural flaps(DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps. Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016. Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p= 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p= 0.01), as was coverage failure (23.7 vs. 2.6%, p= 0.035). Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results. [ABSTRACT FROM AUTHOR]

Soft tissue defects around the foot and ankle region often present an awkward problem for plastic surgeons. The medial plantar artery flap raised from the non-weightbearing instep of the plantar foot offers a thick, sensorial, durable, and glabrous skin. The reversed sural artery flap offers a reliable option for coverage with the advantages of a wide arc of rotation, adequate dimensions, and a reliable blood supply. The present study compared the outcomes of the medial plantar artery flap and the distally based sural artery flap in foot and ankle reconstruction. The present comparative cross-sectional study included 30 adult patients with soft tissue defects in the foot and around the ankle, who were divided into 2 equal groups. One group underwent reconstruction with the proximally based island medial plantar artery flap (MPAF). The second group underwent reconstruction with the reversed sural artery flap (RSAF). The operative time and complications were carefully recorded. The surgical outcomes in terms of flap survival, durability of coverage, and functional outcome were assessed for all patients. No significant differences were found between the 2 groups in age, sex, etiology, or site of the defect. The defect size was significantly smaller in the MPAF group than in the RSAF group (22 ± 2.7 cm 2 versus 66.2 ± 7.7 cm 2 ; p < .001). However, the operative time was significantly longer in the MPAF group than in the RSAF group (100 ± 2.9 minutes versus 80.5 ± 3.1 minutes; p < .001). The flap survived in all cases in the MPAF group, but total flap necrosis occurred in 1 patient in the RSAF group. The mean follow-up period was 13.2 months. Weightbearing was significantly earlier in the MPAF group than in the RSAF group (5.8 ± 0.26 weeks versus 6.9 ± 0.19 weeks; p = .003). None of the 30 patients developed recurrent ulceration. The incidence of complications (33.3% versus 80%) was significantly less in the MPAF group than in the RSAF group ( p = .01). Significantly greater improvement was found in the functional outcomes in the MPAF group compared with the RSAF group ( p = .004). In conclusion, the MPAF and distally based sural artery flap are the 2 flaps available for foot and ankle reconstruction. However, the MPAF offers better functional outcomes with a lower frequency of postoperative complications. Thus, the sensate MPAF is recommended for reconstruction of moderate-size defects of the foot and ankle region. [ABSTRACT FROM AUTHOR]

• The reverse sural artery fasciocutaneous (RSAF) flap was performed in older patients to repair soft tissue defects of the lower extremities. • Although the RSAF flap in older adult patients shows a higher wound complication rate than in younger patients, all flaps survived. • The RSAF flap can be a reliable salvage option to repair soft tissue defects of the lower extremities in older adult patients. The reverse sural artery fasciocutaneous (RSAF) flap is a popular option for patients with soft tissue defects of the distal lower extremities. However, most studies have focused on young patients without comorbidities. This study aimed to report the clinical application of the RSAF flap and to evaluate its reliability in older adult patients. A retrospective study of fifty-one patients who underwent RSAF flap was included in this study between September 2016 and October 2021. Reconstruction outcomes and wound complications were compared between groups A (21 patients over 60 years of age) and B (30 patients under 60 years of age). Overall, 74.5% of the flaps healed primarily. The demographics of the two groups were similar, except for comorbidities (P = 0.01). The risk factors that affected the survival of RSAF flaps were not significantly different between the two groups (P > 0.05). The rate of wound complications in group A (42.85%) was significantly higher than that in group B (13.3%) (P = 0.04). However, all wound complications were treated using a simple procedure (skin grafting or simple suturing). The RSAF flap can be a reliable salvage option to repair soft tissue defects of the lower extremities in older adult patients. It is safe and easy to harvest and transfer the flap; however, surgeons should be aware of the possibility of wound complications in older patients with comorbidities. [ABSTRACT FROM AUTHOR]

Entre las técnicas reconstructivas de miembros inferiores se encuentra el colgajo neurocutáneo de flujo reverso utilizando el paquete neurovascular sural, técnica conocida pero con escasa experiencia publicada en infantes. El objetivo de este trabajo es presentar y analizar 10 casos clínicos en los que se utilizó el colgajo sural reverso en pacientes de edad pediátrica. Realizamos un estudio retrospectivo, descriptivo y observacional, que incluye a todos los pacientes menores de 16 años a los que se les realizó una reconstrucción con colgajo sural reverso durante el período comprendido entre marzo del 2004 y abril del 2010 en el Centenario Hospital Miguel Hidalgo de Aguascalientes, México. Se incluyeron 10 casos con una mediana de edad de 10 años (rango de 3 a 15 años), 6 masculinos y 4 femeninos. El mecanismo del trauma en 6 de los casos fue por lesión en motocicleta, en 2 paientes atropello por automóvil, 1 caso por lesión en bicicleta y 1 caso con lesión por proyectil de arma de fuego. Las áreas afectadas fueron región dorsal del pie en 5 casos, región calcánea en 4 casos, y una lesión maleolar externa. La mediana del diámetro de las superficies afectadas fue de de 8.8 cm. Tres pacientes presentaron complicaciones postoperatorias menores, 2 epidermólisis distales y 1 dehiscencia parcial del colgajo. No se presentó ninguna complicación grave ni hubo perdidas de colgajos. Los resultados fueron considerados como favorables en el 100 % de los pacientes al término del seguimiento. La técnica de reconstrucción del miembro inferior, específicamente en el caso de lesiones en pie, con colgajo neurocutáneo sural en isla de flujo reverso es, a nuestro juicio, una opción eficaz de tratamiento también para pacientes pediátricos.Among the lower leg reconstructive techniques, the reverse sural neurocutaneous flap is a well known technical option, with little experience reported in infants. Our aim is the pesentation and analysis of 10 cases of pediatric patients in which we used the reverse sural flap. We follow a retrospective, descriptive and observational study that includes all patients under 16 years who received a reverse sural flap reconstruction within the period between March 2004 and April 2010 at the Centenario Hospital Miguel Hidalgo in Aguascalientes, México. The study included 10 cases with mean age 10 years (range 3 to 15 years), 6 males and 4 females. The mechanism of trauma in 6 cases were motorcycle injury, car crash in 2 patients, 1 case of bicycle injury, and 1injury by fire arm. The affected areas were foot dorsal area in 5 cases, calcanea in 4 cases and 1 external ankle injury. The average diameter of the affected areas was 8.8 cm. Three patients had minor postoperative ccomplications, 2 distal epidermolysis and 1 partial dehiscence of the flap. There were no serious complications or flap loss. Favorable results were obtained in 100 % of patients at the end of the follow up. In our opinion, the technique of lower leg reconstruction, specifically for foot lesions, with sural neurocutaneous flap of reverse flow is an effective treatment option for pediatric patients.

As a result of the development of microsurgery techniques and anesthesiological care, free flaps are the most common method of choice for covering extensive tissue loss of the area of the shank. However, this technique has its limitations that are caused by impaired function of the donor site due to e.g. vascular changes, advanced arteriosclerosis, diabetes or damage caused by radiation. Prolonging the duration of the surgical procedure is not always possible due to the patient's general condition and could result in an unnecessary increase in the risk of postoperative complications. Posttraumatic lesions may lead to damage of the large blood vessels of the lower extremity and the use of microsurgery techniques in such cases is associated with a greater risk of complications. The use of local tissue or advancement flap techniques in the lower part of the shank and foot is extremely limited because of soft tissue deficiency and its low mobility. In such cases, the use of fasciocutaneous local flaps is a suitable alternative to free flaps. The aim of this study was to evaluate the use of a reverse sural flap in treating cutaneous and subcutaneous tissue loss in the distal 1/3 area of the shank, ankle and heel. [ABSTRACT FROM AUTHOR]

Introduction Prevalence of giant cell tumor (GCT) at atypical locations like bones of the feet are rare, seen in <1% of cases. GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Difficult diagnosis most often followed with complicated management and high recurrence rate remains a challenge that is rarely reported. Presentation of case We presented a case of forty-six-year-old male patient with giant cell tumor of the right calcaneus Campanacci 3 with secondary aneurysmal bone cyst (ABC). Wide excision total calcaneoctomy, followed by reconstruction bone defect using femoral head allograft and soft tissue coverage with sural flap had been done. Discussion Conservative surgery with careful curettage and placement of bone cement should be considered the treatment of choice when feasible. However, aggressive GCTs may require wide excision and reconstruction or may be amputation. We decided to do salvage surgery since: traditionally curettage is not possible, adequately wide resection of local tumor could be achieved, neurovascular bundle was not involved, and also bone and soft tissue reconstructions could be done. In addition, he refused for amputation. Conclusion Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation. [ABSTRACT FROM AUTHOR]

Summary Objective The reconstruction of complex lower leg and foot defects is difficult for plastic surgeons. The distally based sural flap (DBSF) is an option for non-free flap lower leg reconstruction. However, one of the major drawbacks of the DBSF is its aesthetically non-acceptable donor area scarring. Materials and methods Eight patients (six men and two women) who had lower leg or foot defects were evaluated in this study. We used an ipsilateral or cross-leg DBSF to repair the defect. A medial or lateral gastrocnemius perforator island flap (average size 8.1 × 6.1 cm) was used to cover the donor area of the DBSF in a two-stage operative procedure. Results We did not observe any complications with the gastrocnemius perforator island flap. Two patients had local infections under the DBSF and were treated with bacteria-specific antibiotherapy. All patients were followed up for 1 year postoperatively. The donor areas of the distally based sural flaps were aesthetically acceptable. Patients gained ambulatory status during the follow-up period. Conclusions Reconstruction of the donor area of a DBSF with a gastrocnemius perforator island flap allows for more acceptable aesthetics and functional results than do other reconstructive procedures. [ABSTRACT FROM AUTHOR]

Introduction: The reconstruction of soft tissue defects with dead spaces in the heel and ankle is challenging. This article describes our experience in the reconstruction of such defects using the reverse sural flap with an adipofascial extension. Method: Reverse sural flaps with an adipofascial extension were used in 26 patients with soft tissue defects in the heel ( n = 24) or ankle ( n = 2). Extended adipofascial tissue was utilized to fill the dead space. The sizes of the adipofascial extensions varied from 2.0 to 5.0 cm in length and 4.0 to 12.5 cm in width. Result: Twenty-three flaps survived completely, and lateral marginal necrosis occurred in three flaps. All the recipient-site wounds healed without any signs of infection. The reconstruction outcomes were excellent in 20 patients and good in 6 patients according to the criteria of Boyden et al. Conclusion: The extended adipofascial tissue of the reverse sural flap improves closure of the dead spaces in soft tissue defects of the heel and ankle and thus provides beneficial conditions for the treatment of infection and reconstruction of both the function and contour of the soft tissue defects with dead spaces in the heel and ankle. [ABSTRACT FROM AUTHOR]

Partial flap loss is a common complication of the distally based sural fasciocutaneous flap. We present a modified technique of a sloped skin island design to improve the reliability of the flap when used to reconstruct a longitudinal distal pretibial defect or transverse heel and ankle defect. Thirty-one flaps with the slope-designed skin island were used to reconstruct such defects in 30 patients. In the modified technique, the skin island was rotated toward the vascular axis of the flap. The defects were located in the distal pretibial region in 7 cases and the ankle and heel region in 24. The horizontal dimension of the skin island decreased by an average of 5.6 (range 2.5 to 14.8) cm with the sloped design, and the rotation angle varied from 42° to 90° (mean 69°). Of the 31 flaps, 29 survived, 1 developed marginal necrosis, and 1 developed lateral partial necrosis. The sloped design of the skin island is applicable to reconstruction of longitudinal distal pretibial or transverse heel and ankle defects. The modified technique can decrease the horizontal dimension and increase perfusion of the skin island, thus improving the reliability of the flap. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, the distally based neurocutaneous sural flap has become the best known neurocutaneous flap of the leg. When microsurgical expertise is not available or feasible, the sural flap has become the mainstay of reconstruction for lower leg, ankle and foot defects. Matherial and method: The large series of cases published in the medical literature, innovations, technique modifications along with risk factors identification has been followed by this flap rise in popularity. 64 publications on the sural flap subject, in the international literature, were summarized in this study. The relevant anatomy reviewed in anatomical studies is presented in order to understand the circulation and tissue composition of the sural flap. The surgical technique and its various modifications are highlighted, in order to make proper indications and minimize complications. Risk factor identification is presented in order to preclude unfitted patients from this flap. Several clinical cases from the senior author are ilustrated. Conclusion: The distally based neurocutaneous sural flap offers a reliable and versatile technique, alternative to free flap transfer, for the treatment of complex lower limb defects in healthy or vascularly compromised patients. [ABSTRACT FROM AUTHOR]

Traumatic injury to the pediatric growth plate can result in growth disturbances, late angular deformity, and limb length inequalities. Complete traumatic loss the entire growth plate complex (physis, epiphysis, and distal metaphysis) of the ankle can lead to severe joint instability and loss of function. In the growing child, physeal preservation is paramount; however, the reconstructive options are limited. We report a case of posttraumatic loss of the distal fibular physis resulting in severe ankle valgus in a pediatric patient after a Gustilo grade 3B open injury. Ankle valgus secondary to post-traumatic necrosis of the lateral ankle physeal complex was successfully managed by microvascular free transfer of the ipsilateral proximal fibula physis. The 24- month follow-up examination demonstrated continued growth of the free vascularized physeal graft and a stable ankle. The donor site had healed without incident. The patient was able to return to age-appropriate play, sports, and social integration. [ABSTRACT FROM AUTHOR]

Objective: The distally based neurofasciocutaneous sural flap is central to the armamentarium for the reconstruction of leg's distal third, ankle, and hindfoot. Despite the use of adapted techniques aimed at increasing the flap's reliability, venous congestion remains a frequently encountered problem. We present a venous super-drainage technique used by the senior author to reduce venous congestion and improve flap reliability when harvesting larger flaps. Methods: A retrospective chart review, from January 2002 to October 2008, at 2 tertiary care centers, was conducted on all cases of inferior limb reconstruction with reverse sural flaps on defects greater than 10 × 5 cm. In addition, a literature review was carried out to examine the average sural flap surface area and reported complications published from 1992 to 2012. We then compared our results with those published in the literature. Results: A total of 15 flaps were identified. Mean flap dimensions were 14 × 8.5 cm (mean area = 115.27 cm2; 95% confidence interval, 99.28-131.26). None of the flaps developed complications (arterial or venous insufficiency, partial/complete necrosis). The average flap surface area in the literature is 55.08 cm2, with a 22% rate of total complications.We harvested significantly larger flaps (P < .001) with a significantly lower total complication rate (P < .05) when compared with that reported in the literature. Conclusion: Anastomosing the proximal end of the lesser saphenous vein with a vein at the defect site improves venous outflow, effectively reducing the incidence of venous congestion, increases the potential flap size, and improves reliability. [ABSTRACT FROM AUTHOR]

In ankle and heel region, tissue defects can be occurred due to diabetes, osteomyelitis, trauma and tumor excisions and these defects should be repaired with flaps. Reverse-flow sural island flap is a reliable alternative for repairing these regions' defects. Delayed reverse-flow sural island flap procedure was applied for 11 smoker or diabetic patients who have tissue defects due to trauma. While we haven't seen flap failure in any patient, we also didn't have any difficulty except 2 minor problems. Besides clinical results, patient satisfaction was evaluated with "patient satisfaction rate scale". In this article, it is reported our ankle and heel reconstruction cases with delayed reverse-flow sural island flap as an alternative of free flap and their satisfaction rate. [ABSTRACT FROM AUTHOR]

Background The treatment of chronic calcaneal osteomyelitis remains a challenge for orthopedic and plastic surgeons. The basis of surgical therapy includes thorough debridement of infected tissue and reconstruction with well-vascularized flaps. Methods A "hybrid" sural flap composed of an adiponeurofascial flap proximally and a neurofasciocutaneous flap distally is described here. The adiponeurofascial flap was used to obliterate the bone cavity, and the distal part was used to resurface soft tissue defects. Five patients with chronic calcaneal osteomyelitis were treated with this modified sural flap. Results The size of the adiponeurofascial flap ranged from 5.0 x 4.0 cm to 13.0 x 5.0 cm, and that of the neurofasciocutaneous flap ranged from 6.5 x 3.0 cm to 6.0 x 8.0 cm. The donor defects were covered with skin grafts in three patients and closed primarily in two patients. All the flaps survived completely without any complications, the skin graft and the skin over the adiponeurofascial flap healed uneventfully. There was no evidence of recurrent infection during the follow-up period. Conclusion The modified "hybrid" sural flap is simple and reliable and is a good candidate for treatment of chronic calcaneal osteomyelitis. [ABSTRACT FROM AUTHOR]

There are no large series comparing the distally based perforator-plus sural fasciocutaneous flap used in pediatric and adult populations. The flaps were divided into two groups: the children (patient's age < 14 years) group (n = 53) and the adults (patient's age ≥ 18 years) group (n = 148). We compared flap-viability-related complications and their potential risk factors. In the patients with at least 12-month postoperative follow-up, the reconstruction outcomes, donor-sitemorbidities, and transitory and permanent swelling of the affected lower limb were compared. Partial necrosis, marginal necrosis, and overall complication rates were 13.2, 3.8, and 17.0% in the pediatric group, and 12.2, 1.4, and 13.6% in the adult group, respectively; the differences were not statistically significant (p > 0.05). Incidences of hypertrophic scar and pruritus at the donor site were significantly higher, while incidence of transitory swelling of the affected lower limb was significantly lower in the pediatric group. This flap in children is similar to that in adults in the reliability. [ABSTRACT FROM AUTHOR]

Summary: The distally based sural fasciocutaneous flap is one of the few options available for local flap reconstruction of soft-tissue defects in the lower one-third of the leg. Few studies have assessed risk factors associated with poor outcomes in this flap. A literature search was performed of MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles evaluating the use of sural artery fasciocutaneous flaps for soft-tissue reconstruction of the leg. Data were pooled and a univariate analysis was performed to identify characteristics associated with increased morbidity. A logistic regression model was created, and odds ratios and p values associated with the development of complications were calculated. Sixty-one papers were identified which included data on 907 patients. The majority of sural flaps were used to cover defects of the heel (28.2%), foot (14.4%) or ankle (25.8%). Trauma was the most common indication, followed by ulcers and open fractures. Flap complications were recorded in 26.4% of cases with a flap loss rate of 3.2%. With multivariate analysis, venous insufficiency and increasing age were independent risk factors for complications. Patients with venous insufficiency had nine times the risk of developing a complication compared to patients without venous insufficiency. [Copyright &y& Elsevier]

Aims: To describe a case of simultaneous medial and lateral soft tissue coverage for exposed orthopaedic implants in the setting of revision fixation of a non-united ankle fracture. This was achieved using a sural flap as well as a propeller flap. Methods: Case report. Results: Both the sural and posterior tibial artery based rotational propeller flap healed without incident. The underlying fracture healed successfully and the patient returned to normal shoe wear. Conclusions: The sural flap in conjunction with the posterior tibial artery based rotational flap is effective in providing simultaneous medial and lateral soft tissue coverage to the ankle. [ABSTRACT FROM AUTHOR]

Background: The coverage of soft tissue defects in the lower extremity has proven to be challenging. The reverse sural flap provides reliable coverage with minimal complications. Methods: Six patients with sarcomas at the distal leg, ankle, and foot were treated with the reverse sural artery flap. Data was gathered for demographics, comorbidities, type of tumor, size of defect, flap viability, healing time, donor-site morbidity, recurrence, functional outcome, and range of motion. Results: All patients possessed a primary sarcoma that traditionally would have required a free flap for coverage. The average size of defect was 94 cm (range 50-143) and was covered by flaps that ranged between 10 × 13 cm and 10 × 5 cm. Flap viability was 100 %, with healing occurring by 18 weeks (range 4-32 weeks). Donor-site morbidity was 0 %. Average revised MSTS score was 80 % or 24/40 (range 15-29). Average ROM for dorsi flexion was 0 ° and plantar flexion was 17.5 ° (range 10-25). Average time of follow-up was 8.75 months (range 4-14). Conclusions: In most patients without associated risk factors such as diabetes, the reverse sural flap can be performed safely. However, in patients with identifiable risk factors for partial flap failure, consideration should be given to alternative options such as free flap reconstruction in order not to delay or interrupt adjuvant radiotherapy. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

The use of local flaps for the reconstruction of leg has lost their popularity with themore often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weightbearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Foot and ankle soft-tissue defects constitute a real challenge to reconstructive surgeons because of restricted local soft tissue availability. We report a 28 years old male with a significant soft-tissue defect on the left anteromedial ankle and dorsal foot., Case Presentation: A 28 years old male with soft-tissue necrosis on the left anteromedial ankle and dorsal foot, as well as second - fourth metatarsal fractures with gangrene of the first - third phalanx, presented to our hospital 14 days after a traffic accident. He underwent debridement and amputation of the gangrenous fingers. In the second operation, a pin fixation of the metatarsal fractures and the reverse sural flap was performed. The donor site was covered with a split-thickness skin graft. The wounds began to improve significantly on the tenth day after the surgery, and his wounds were gone entirely in the third week. The pins were removed eight weeks after the surgery with the fractures healed., Clinical Discussion: Skin grafts are easy and quick to cover open wounds but cannot be applied to cover bare tendons or bone. Local flaps of the distal third of the lower extremity have a limited range of motion and arc of rotation. Free flaps are an acceptable but complex reconstructive surgery that requires long operative time, special instruments, and microsurgical training and are expensive., Conclusion: The reverse sural flap was considered feasible in reconstructing patients with soft-tissue defects of the distal leg, ankle, and foot, especially in resource constraint scenarios., Competing Interests: All authors declare no conflicts of interest., (© 2022 The Authors.)

Background: The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ankle ulcers. Methods: A systematic review was undertaken from MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Only diabetic foot and ankle ulcers were accepted for inclusion and all study designs were included. Proximally based flaps, nondiabetic ulcers, and assisted negative pressure therapy were excluded. Suitability for inclusion was assessed by 2 reviewers. The random-effect estimate was reported for the set outcomes whenever high heterogeneity was present. Metaregression analysis was performed to identify independent risk factors for failure. Results: The search identified 33 relevant studies comprising 187 patients and flap interventions; all but 1 were case-series. The weighted outcomes were as follows: (1) the flap healing rate was 93.3% while 6.6% resulted in total necrosis, (2) the rate of partial flap necrosis was 12%, (3) venous congestion was reported in 6.6% of cases, (4) the infection rate was 8.3%, and (5) the donor site morbidity was 4.6%. No association was found between pedicle width or presence of a subcutaneous pedicle tunnel and the primary outcome of total loss. Conclusions: This review demonstrated excellent results of the flap when covering complicated or large diabetic foot and ankle ulcers. When compared to those published in the literature, our results found RSFCF to be relatively less successful in diabetic wounds than in trauma patients but more successful than in those having associated osteomyelitis and those who were treated with random local flaps., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Author(s).)

Objective: To compare the use of distally based Sural Artery flap in old and young patients. Design: Descriptive and Clinical study. Setting & Period: Dept. of Plastic Surgery and Dept. Of Orthopedic Surgery, Dow University of Health Sciences & Civil Hospital, Karachi. Patients & Methods: The records of all patients who under went reapir of their defect with Distally based Sural Artery flap were sought and examined in detail. First age of the patients was seen and records were divided into two groups. One group of patients above 40 years and other group of patient below 40 years. Among the two groups every patient record was scrutinized for site of the wound, co-morbidity, procedure done, any complications noted, stay of the patient, number of procedures done and final outcome. Results: Twenty seven (27) were gathered in two groups. In the first group there were 15 patients and in second group there were 12 patients. In the first group(<40 years) there was complete survival of 8 flaps out of 15(53%). There was marginal necrosis of the distal margin in 6 cases (25%) and complete necrosis in one case (7%). In the second group (>40 years) there was complete survival of 3 flaps out of 12 (25%). There was marginal necrosis of the distal margin in 5 cases(42 %) and complete necrosis in four cases e(34%).So overall survival rate in the first group was 93% and in the second group it was 66%. Conclusion: Looking at the complication of DBSA flap in patients above 50 it can be concluded that it should be avoided, if, possible, especially if co-morbidities like Diabetes Mellitus, peripheral vascular disease, ischemic heart disease, vasculitis or any other co exist. [ABSTRACT FROM AUTHOR]

Among the lower leg reconstructive techniques, the reverse sural neurocutaneous flap is a well known technical option, with little experience reported in infants. Our aim is the pesentation and analysis of 10 cases of pediatric patients in which we used the reverse sural flap. We follow a retrospective, descriptive and observational study that includes all patients under 16 years who received a reverse sural flap reconstruction within the period between March 2004 and April 2010 at the Centenario Hospital Miguel Hidalgo in Aguascalientes, México. The study included 10 cases with mean age 10 years (range 3 to 15 years), 6 males and 4 females. The mechanism of trauma in 6 cases were motorcycle injury, car crash in 2 patients, 1 case of bicycle injury, and 1 injury by fire arm. The affected areas were foot dorsal area in 5 cases, calcanea in 4 cases and 1 external ankle injury. The average diameter of the affected areas was 8.8 cm. Three patients had minor postoperative complications, 2 distal epidermolysis and 1 partial dehiscence of the flap. There were no serious complications or flap loss. Favorable results were obtained in 100% of patients at the end of the follow up. In our opinion, the technique of lower leg reconstruction, specifically for foot lesions, with sural neurocutaneous flap of reverse flow is an effective treatment option for pediatric patients. [ABSTRACT FROM AUTHOR]

Abstract: Repairing distal lower limb soft tissue defects remains challenging for reconstructive surgeons. Relatively few procedures have real efficiency and low morbidity. Since its initial description, the distally based sural flap has been used increasingly for this indication. However, controversy exists about the upper limit of the skin paddle of the sural flap. In the present series, 11 patients underwent surgery with distally based sural flaps. In 6 patients, the flap skin paddle was partially or totally placed beyond this controversial limit on the proximal calf region. To increase the skin irrigation of this region, whole mesenteric tissue under the deep fascia of the leg was included in the flap. Venous congestion and distal tip necrosis can impair the success of flap surgery. To overcome these problems, the flap pedicle was not passed through the subcutaneous tunnel. All flaps survived completely, and no cases of venous congestion developed. Thus, extending the donor area to the upper part of the leg is a reliable maneuver to repair more distal defects of the leg and foot, and abstaining from passing the pedicle through a subcutaneous tunnel could contribute to a decreased risk of venous congestion. [Copyright &y& Elsevier]

Pes equinovarus is a congenital disease that can be successfully treated with serial casting and percutaneous achillotomy at the newborn stage in most of the cases. Complex surgical interventions are required for patients presenting at advanced age for correction of this deformity. The main problem encountered in the treatment for neglected pes equinovarus cases is repairing the posteromedial skin defect of the ankle due to surgical correction of this deformity. 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. In this article, the technical details of sural flap application in cases with neglected pes equinovarus and the preliminary results of three extremities treated with this method have been presented. [ABSTRACT FROM AUTHOR]