Different Methods for Improving the Outcomes of Distally Based Sural Flap for Foot and Ankle Reconstruction

  • Ibrahim S. Rihan
  • Hamdy M. Hussein
  • Samia M. Saied
  • Ahmed A. Abdelrahim
Keywords: Sural flap, foot and ankle reconstruction


Introduction: Reconstruction of soft tissue defects of the lower third leg and foot
presents a great challenge for the reconstructive surgeons. The distally based sural flap
provides a good option for coverage. However, some complications usually occur
specially venous congestion and edema, different modifications had made to reduce
complications and to increase the reliability and outcomes of the flap. Our goal is to
describe the most frequent errors and methods to overcome the incidence of these
complications. Some of these methods are supercharging the flap, delaying the
flap,exteriorize the lesser saphenous vein, leg elevation, orientation of the flap,
increasing the width of the pedicle, incorporating a gastrocnemius muscle cuff around
sural pedicle, lowering the pivot point or any other methods to overcome the incidence
of complication. Patients and methods: A total of 30 patients, there were 24 were
males(80%) and 6 were females(20%) , the average patient age was 37 yrs ( ranges from
5 to 69yrs ), in 14 patients defects were post traumatic skin defects (46%), in 6 patients
defects were due to unsteady scars(20%), in 5 patients skin defects were due to diabetic
ulcers(16.5%) , in 4 patients defects were trophic ulcers (13.5%) , and one patient had
post amputation raw area with exposed bone(4%).The reconstructed sites were the
weight-bearing heel in20 patients, the dorsum of the ankle in 4 patients, the dorsum of
the foot in 3 patients, and the mid foot in 1 patient, lower third of the leg in 2 patients.
Results: All patients were followed up for a period from 6 to 12 months (mean= 9
months), minor complications had occurred such as three cases (3cases) with superficial
epidermolysis (10%) (three cases need debridment one of them healed by secondary
intention and two need skin graft) , two cases (2cases) complicated with loss of the graft
on pedicle which need another skin graft(7%), one case (1case) with partial flap necrosis
at the distal part which need debridment and healed by secondary intention(3.5%), and
two cases (2cases) with partial dehiscence of the flap which treated by debridment and
restitch (7%) .The flaps usually healed eventually by 3rdto 4th week but full weight
bearing on them postponed up to 6th or 8th week and the patients were satisfied with the
functional and aesthetic outcomes. Conclusion: The distally based the sural flap is a
versatile flap for the reconstruction of soft tissue defects of the lower leg and heel.
Despite its complications, some modifications are available to overcome these
complications and increase its reliability.