Reverse-Flow Island Sural Flap
- 1 February 2002
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 109 (2), 583-591
- https://doi.org/10.1097/00006534-200202000-00027
Abstract
The reverse flow island sural flap is presented as an alternative to flaps currently used for reconstruction of small and medium substance losses in the distal third of the leg, ankle, and heel. This is a random type of flap, based on the reverse flow of the superficial sural artery, which mainly depends on the anatomy of the perforators of the peroneal artery system. The anatomic structures that constitute the pedicle are the superficial and deep fascias, the sural nerve, the short saphenous vein, and the superficial sural artery. The skin island and the subcutaneous cellular tissue complement the flap proper. This skin island was demarcated at any point of the median or distal thirds of the leg, having the short saphenous vein and the sural nerve on its central axis. The distal dissection limit of the pedicle is located 5 centimeters above the lateral malleolus. This limit is established so as to ensure the integrity of the perforators from the principal arteries of the leg, mainly the peroneal artery, responsible for the reverse flow nourishing the flap. These perforators will affect anastomoses with the superficial sural artery in charge of irrigating the structures compounding the flap.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 mellitus, and some others having proven vascular insufficiency or displaying unstable areas attributable to problems such as pseudarthrosis and osteomyelitis, which needed to be covered. Fifteen flaps (21.1 percent) suffered partial necrosis, which did not compromise the final result, and another three (4.2 percent) showed total loss. The flap in question has great mobility and versatility, allowing the treatment of specific areas of the lower limb, without sacrificing important arteries or mobilizing structures that might bring about functional deficits.Keywords
This publication has 16 references indexed in Scilit:
- The Posterolateral Malleolar Flap of the AnklePlastic and Reconstructive Surgery, 1995
- Heel Coverage with a T-shaped Distally Based Sural Island Fasciocutaneous FlapPlastic and Reconstructive Surgery, 1994
- Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial NervesPlastic and Reconstructive Surgery, 1992
- The Reversed Fasciosubcutaneous Flap in the LegPlastic and Reconstructive Surgery, 1991
- Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: preliminary report of a new fasciocutaneous flapBritish Journal of Plastic Surgery, 1986
- Venous Drainage in the Reverse Forearm FlapPlastic and Reconstructive Surgery, 1984
- WILLIAM HARVEY REVISITED: REVERSE FLOW THROUGH THE VALVES OF FOREARM VEINSThe Lancet, 1984
- Distally Based Fasciocutaneous Flap from the Sural RegionScandinavian Journal of Plastic and Reconstructive Surgery, 1983
- The Lateral Calcaneal Artery Skin Flap (The Lateral Calcaneal Artery, Lesser Saphenous Vein, and Sural Nerve Skin Flap)Plastic and Reconstructive Surgery, 1981
- The fasciocutaneous flap: its use in soft tissue defects of the lower legBritish Journal of Plastic Surgery, 1981