Timing of Postoperative Flap Sensations in Patients Who Underwent Reconstruction with a Reverse Flow Sural Flap

Introduction: The algorithm for reconstruction options for lower extremity soft-tissue defects depends on the location, size, and depth of the wound. Regional options include muscle, fasciocutaneous, perforator, supramalleolar, and sural flap. In this study, we aimed to evaluate the return time of postoperative sensory innervations in patients whose reconstruction was performed with a reverse flow sural flap in distal third lower extremity injuries. Materials and Methods: Patients with lower extremity injuries, treated between September 2018 and December 2021, were retrospectively evaluated in terms of sensory innervation of the sural flap at 1, 6, 12, and 18 months postoperatively. Heat, cold, pain, stereognosis, two-point discrimination, and superficial and deep sensory examinations were examined in stages. Results: A total of 12 patients were evaluated, 7 (58.3%) of whom were male and 5 (41.6%) were female. The mean age of the patients was 42.08 years. The mean follow-up period of the patients was 20 months. In the acute postoperative follow-up of the operated patients, infection was observed in three patients and venous congestion in one patient. Total flap loss was not observed in any patient. The superficial sensory test and the deep sensory test did not return until a mean of 6 months, and the stereognosis test did not return until 1 year, while the sensation of pain returned at an average of 18 months, and the heat, cold, and two-point discrimination tests did not return during follow-up in most patients. Conclusion: The reverse flow sural flap is a reconstruction option known to have rapid neurosensory recovery. The exact timing to minimize the risk of trauma that may occur in the flap area is an average of 18th month. Although larger studies are needed to support these results, studies to accelerate the sensory innervation of this flap are needed.