DOI QR코드

DOI QR Code

Versatility of the Distally-Based Sural Artery Fasciocutaneous Flap on the Lower Leg and Foot in Patients with Chronic Disease

  • Park, Jin-Su (Department of Plastic and Reconstructive Surgery, Chonbuk National University School of Medicine) ;
  • Roh, Si-Gyun (Department of Plastic and Reconstructive Surgery, Chonbuk National University School of Medicine) ;
  • Lee, Nae-Ho (Department of Plastic and Reconstructive Surgery, Chonbuk National University School of Medicine) ;
  • Yang, Kyoung-Moo (Department of Plastic and Reconstructive Surgery, Chonbuk National University School of Medicine)
  • Received : 2013.02.20
  • Accepted : 2013.03.21
  • Published : 2013.05.15

Abstract

Background A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However, the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients. Methods Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment. Results The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1). Conclusions The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.

Keywords

References

  1. Fraccalvieri M, Verna G, Dolcet M, et al. The distally based superficial sural flap: our experience in reconstructing the lower leg and foot. Ann Plast Surg 2000;45:132-9. https://doi.org/10.1097/00000637-200045020-00006
  2. Chen SL, Chen TM, Wang HJ. The distally based sural fasciomusculocutaneous flap for foot reconstruction. J Plast Reconstr Aesthet Surg 2006;59:846-55. https://doi.org/10.1016/j.bjps.2005.10.013
  3. Serafin D, Georgiade NG, Smith DH. Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot. Plast Reconstr Surg 1977;59:492-9. https://doi.org/10.1097/00006534-197759040-00003
  4. Swartz WM, Mears DC. The role of free-tissue transfers in lower-extremity reconstruction. Plast Reconstr Surg 1985; 76:364-73. https://doi.org/10.1097/00006534-198509000-00005
  5. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981;34:215-20. https://doi.org/10.1016/S0007-1226(81)80097-5
  6. Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Reconstr Surg 1983;17:191-6. https://doi.org/10.3109/02844318309013118
  7. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987;40:113-41. https://doi.org/10.1016/0007-1226(87)90185-8
  8. Taylor GI, Pan WR. Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 1998;102:599-616. https://doi.org/10.1097/00006534-199809010-00001
  9. Rios-Luna A, Villanueva-Martinez M, Fahandezh-Saddi H, et al. Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb. Injury 2007;38:824-31. https://doi.org/10.1016/j.injury.2006.07.007
  10. Baumeister SP, Spierer R, Erdmann D, et al. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 2003;112:129-40. https://doi.org/10.1097/01.PRS.0000066167.68966.66
  11. Tan O, Atik B, Bekerecioglu M. Supercharged reverse-flow sural flap: a new modification increasing the reliability of the flap. Microsurgery 2005;25:36-43. https://doi.org/10.1002/micr.20072
  12. Wong CH, Tan BK. Intermittent short saphenous vein phlebotomy: an effective technique of relieving venous congestion in the distally based sural artery flap. Ann Plast Surg 2007;58:303-7. https://doi.org/10.1097/01.sap.0000238458.33475.ca
  13. Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 1999;103:104-20. https://doi.org/10.1097/00006534-199901000-00018

Cited by

  1. Clinical Application of Adipose Stem Cells in Plastic Surgery vol.29, pp.4, 2014, https://doi.org/10.3346/jkms.2014.29.4.462
  2. Perforator Flap versus Conventional Flap vol.30, pp.5, 2013, https://doi.org/10.3346/jkms.2015.30.5.514
  3. Revisit of the anatomy of the distal perforator of the descending genicular artery and clinical application of its perforator “propeller” flap in the reconstruction of soft tissue defects vol.35, pp.5, 2013, https://doi.org/10.1002/micr.22340
  4. Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps vol.42, pp.5, 2013, https://doi.org/10.5999/aps.2015.42.5.619
  5. Reconstruction of the lateral malleolus and calcaneus region using free thoracodorsal artery perforator flaps vol.36, pp.3, 2013, https://doi.org/10.1002/micr.22389
  6. Application of acellular human dermis and skin grafts for lower extremity reconstruction vol.28, pp.4, 2019, https://doi.org/10.12968/jowc.2019.28.sup4.s12