Sep 22, 2015 the reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is increasingly being used for coverage of defects that involve the distal third of the leg, ankle, and foot. The understanding of the skins vascular anatomy has improved in the last decade. Pdf the reverse sural fasciocutaneous flap for the treatment of. Sural flap is fasciocutaneous flap, made up of skin, subcutaneous fat, superficial and deep fascia of the posterior part of the lower leg, sural nerve, sural vein, and superficial sural artery. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Defects at this site will often require flap cover. The reverse superficial sural artery flap revisited for complex. The distally based superficial sural flap for reconstruction of the. The main perforators of the medial sural artery are located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among surgeons. Alt flap and reverse sural flap for simultaneous soft. The most common usage of the flap is for the distalthird defects of the leg. Microchip cat flap pet care product pdf manual download.
The technique is based on the use of a reverseflow island sural flap combined with. 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. Modified distally based peroneal artery perforator flap. Pdf reverseflow medial sural artery perforator flap. Reverse sural flap for ankle and heel soft tissues. Sshaped reverse sural flap for reconstruction of tissue defect on. A reverse sural artery flap was raised without transecting the sural nerve to cover the distal part of the defect. The distally based sural fasciomusculocutaneous flap for. The reverse sural artery flap rsaf and distal peroneus brevis flap dpbf have gained popularity for lower third leg defects among. Posttraumatic wounds and soft tissue defects in the distal third of the leg and ankle remain a challenge. The reverse sural nerve flap is one of many versatile neurofasciocutaneous techniques available for staged reconstruction of lower limb and foot.
Distallybased sural flap nattakul yamprasert, md department of orthopaedics, maharat nakhon ratchasima hospital regional hand meeting 2015 the diversity of the hand and upper extremity surgery august 20th 21st, 2015 at ubon ratchathani, thailand 2. Pdf the distally based sural fasciocutaneous flap has become a main part of the. A 57yearold male patient presented with a soft tissue defect and infection on the right lateral malleolar area of the ankle joint a. We combined method the tumor excision for malignant melanoma and performed sural flap to closure the soft tissue defect after performing wide excision tumor. Patients were positioned prone or lateral and a tourniquet was. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
There have been few reports regarding the use of proximally based sural artery flap. Download as an information leaflet pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. The result after performing surgery flap was viable without any complication. The management of soft tissue defects of the lower extremity with underlying osteomyelitis is difficult. This study evaluates the clinical outcomes of using a proximally based sural fasciocutaneous island flap for reconstruction of traumatic softtissue defects around the knee and on the proximal lower leg. The distal part of the exposed bone was covered with the reverse sural artery flap without loss of sensation at anytime to the lateral part of the foot. This is a case series of 20 patients that include a dbspf that was done for defects around ankle, distal leg, and foot. Reverse sural artery flap request pdf researchgate. Versatility of delayed reverseflow islanded sural flap. Considering data from previous studies and this study, the use of the reverse sural flap of the fasciosubcutaneous pedicle or reverse adipofascial flap has a good prognosis. Soft tissue reconstruction of foot and ankle defects with reverse sural. It is a versatile and reliable technique for softtissue reconstruction of the heel and ankle region with 180degrees rotation. The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. Pdf distally based sural artery peroneus flap dbspf.
Jun 05, 2014 almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. Reverse sural artery flap has been proven to be an effective option to cover such defects. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. It is located between the popliteal fossa and the midposterior leg between the medial and lateral heads of the gastrocnemius muscle. Comparison between peroneus brevis flap and reverse sural. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. Pdf reverse sural flap for ankle and heel soft tissues reconstruction. There was no complete flap loss in any of the patients. A tear dropshaped, fasciocutaneous reverse sural artery flap was elevated b and a fasciocutaneous reverse sural artery flap was performed c. From 2007 to 2010, 11 consecutive patients underwent modified reverse sural flap at. The reverse sural fasciocutaneous flap for the treatment of. The flap consists of superficial and deep fascia, the sural. Distally based sural flap for ankle and foot coverage in children.
Surgical anatomy of the medial sural artery perforator flap wong et al. The medial sural artery perforator msap flap is based on musculocutaneous perforators of the medial gastrocnemius muscle. Free flap is ideal for these defects and gives good results but with its own limitations. Twenty patients comprising of males and 7 females with soft tissue defects. Coverage of softtissue defects of the ankle and foot is often challenging. In particular, guidelines for pedicled flap surgery in hemophilia b patients have still not been defined. Pdf distally based sural artery peroneus flap dbspf for. Distally based perforator sural flaps for foot and ankle. A new modification increasing the reliability of the flap. We want to recommend sural flap rahadyan magetsari 1, yudha mathan sakti, arie nugroho 2.
The reverse superficial sural artery flap revisited for comp. At this point, the island flap including the skin, subcutaneous tissue, and the deep fascial tissues containing the neurovascular structures. Distally based sural flap is widely used, however it leaves donor area paresthesia. Almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. Sural flap use for the treatment of wounds with underlying. View and download sure flap microchip cat flap instruction manual online. The reverse superficial sural artery flap revisited for. A proximally based sural fasciocutaneous flap for the. Distally based fasciocutaneous sural flap for foot. The sural flap procedure is a versatile technique that can be used to cover many.
At 1year postoperation, the patient could walk a long distance without a crutch. Malignant soft tissue tumor, wide excision, and sural flap. Pdf acute vascular complication following sural flap. Dec 31, 2016 the reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel. It has the largest arc of rotation of all the regional flaps and does not require sacrifice of any major artery, and moderatetolargesized defects can be covered adequately. In this report of 6 patients underwent surgical reconstruction by this. The medial sural artery perforator msap flap is an increasingly versatile and reliable flap for soft tissue reconstruction. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The sural artery flap is a distally based fasciocutaneous flap that has many advantages to offer for coverage in the foot and ankle area. To overcome this problem, we describe an interpolation flap technique in which subcutaneous tunnelling of. Reverseflow islanded sural flap can be used for reconstructiing a large area, e. Jan 12, 2011 the lateral supramalleolar skin flap offers a range of coverage similar to that of the sural flap, but the dissection is more difficult than for a sural flap and offers no advantages, the remaining nonsensitive area in sural flaps is smaller than the one left after the transection of the superficial peroneal nerve. We evaluated the versatility of this flap and provide further evidence on its use for covering small.
Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. A perforator within this region is routinely present. Utility of proximally based sural fasciocutaneous flap for. A distally based sural fasciomusculocutaneous flap including the sural nerve and a midline cuff of the gastrocnemius muscle can be used for this purpose. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein grafts are rarely needed to reach a recipient site. The small saphenous vein was included to make the venous return easier.
The vascular pedicle included 23 cm wide fasciae, the sural nerve, and the accompanying sural artery. Sural flap can become the answered and alternative solution to closure defect in the calcaneal region. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. The radiating pain was significantly reduced at 1month postoperation. To solve this issue, we propose a distally based sural artery peroneus flap dbspf in which we include superficial portion of the peroneus brevis muscle and its. The aim of this study was to evaluate the functional outcome and its usefulness over conventional distal sural artery flap or other local options available. The reverse superficial sural artery flap rssaf is a distally based fasciocutaneous or adipofascial flap that is increasingly being used for coverage of defects that involve the distal third of the leg, ankle, and foot. Harvest of distally based fasciocutaneous island flap from the lateral sural region with a wide adipofascial pedicle. This is a case series of 20 patients that include a dbspf that was done for defects around ankle, distal leg, and foot caused by. Sshaped reverse sural flap for reconstruction of tissue defect on heel.
This study investigates complication rates and longterm. The management of softtissue defects in the ankle and foot area is a challenging task. Cheon et al 28 and suri et al 29 reported that proximally based fasciocutaneous sural artery flap is useful for reconstruction of softtissue defects around the knee and on the proximal and medial third of the leg. A fasciocutaneous flap with a pedicle preserving its blood and nerve supply was created.
Based sural artery and propeller flaps in reconstruction of soft tissue. A pragmatic evaluation of the role of the medial sural. Distally based sural neurofasciocutaneous perforator flap. The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. The design of the desired flap is centered around the most distal perforator found to ensure the longest possible pedicle fig. Pdf 9 academic content and language evaluation of this article. The success of the reverse sural flap is predicated on the ability to correctly incorporate its vascular supply which is based off the sural nerve and, to a greater extent, the sural artery which provides the true vascular. We applied open tunneling technique for sural flaps. Distally based sural artery peroneus flap dbspf for foot. Wrapping the released common peroneal nerve with a proximally based sural fasciocutaneous flap is a useful option for the treatment of recurrent, common peroneal neuropathy. The authors treated 33 patients for small and mediumsize defects of the foot, caused by work, home, and road accidents, and by venous or diabetic ulcers. We believe that it plays a limited role in improving the reliability of a distally based sural neurocutaneous flap and its venous return by increasing the width of the fascial pedicle. A comparison of fasciocutaneous and adipofascial methods.
The sural artery flap is insensate and is not an option in cases in which sensitivity is an issue. May 24, 2015 kao hk, chang kp, chen ya, wei fc, cheng mh 2010 anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. The reverse superficial sural artery flap rssaf is a popular option. As compared to other distally based sural flaps with neuro. In this report, we present our experience on the use of the reverse sural flap for traumatic foot and ankle reconstruction. Medial sural artery perforator flap plastic surgery key. Technical details of using sural flap in pes equinovarus surgery. In all cases, the flap was cut in its fasciocutaneous variant.
The distally based sural artery flap for ankle and foot. Distally based reverse sural artery flap as an interpolation flap. This flap is based on perforators of the peroneal artery system. This flap is designed on the proximal third of the posterior.
The medial sural artery perforator msap flap shows advantages for reconstruction in the foot and ankle, where bulk is a liability. The patient selection and surgical refinement are discussed. The sural fasciocutaneous flap is a good option in reconstruction of difficult and complex wound in lower leg and foot especially on ankle joint, malleoli. The aim of this study is to analyze the demographic. Rbcp reverse sural flap of the fasciosubcutaneous pedicle.
Sure flap microchip cat flap instruction manual pdf download. To overcome this, we have modified our operative technique, which has produced a more reliable flap. The reverse sural artery flap for the reconstruction of. A case of heel reconstruction with a reverse sural artery.
Medial sural artery perforator free flap msap british. The distally based sural fasciocutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. Distally based perforator sural flaps for foot and ankle reconstruction. Cureus effectiveness of reverse sural artery flap in the. The modifications combine the advantages of the sural neurofasciocutaneous flap and the perforatorbased flap and overcome their shortcomings. This kind of injury commonly occurs when lower limbs get stuck in between the spokes of the wheel. Sshaped reverse sural flap is a modified technique of reconstruction. The sural flap is a fasciocutaneous adipofascial flap based on a distal pedicle, used frequently for covering defects located in the middle to distal third of the calf, ankle and leg. Distallybased sural flap nattakul yamprasert, md department of orthopaedics, maharat. Versatility of delayed reverseflow islanded sural flap for. Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. Article information, pdf download for sural flap use for the. The reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel.
The sural flap proved a considerable versatility at the level of the lower leg from the knee to the ankle and heel as well as for other anatomical regions. The sural artery flap is a type a fasciocutaneous flap based on the sural artery direct cutaneous branch of the popliteal artery. Reconstruction of the foot and lower leg defects by. The clinical outcome of perforator based sural artery and propeller. Surgical anatomy of the medial sural artery perforator flap. A pragmatic evaluation of the role of the medial sural artery.
The flap consists of superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. The reverse superficial sural artery flap rssaf is a popular option for many of these difficult wounds. Apr 02, 2016 the design of the desired flap is centered around the most distal perforator found to ensure the longest possible pedicle fig.
To solve this issue, we propose a distally based sural artery peroneus flap dbspf in which we include superficial portion of the peroneus brevis muscle and its blood. The flap has a potentially long vascular pedicle of large caliber which serves well to allow a local flap about the knee, or as a relatively thin free flap where vein grafts are rarely needed to. Zhang cp, zhang yx 2014 a prospective study of medial sural artery perforator flap with computed tomographic angiographyaided design. The potential of the medial calf integument, as donor site for a free flap based on. Perforatorplus fasciocutaneous flap harvest from the posteromedial sural region.
Hallock gg 2014 medial sural artery perforator free flap. May 05, 2014 this study evaluates the clinical outcomes of using a proximally based sural fasciocutaneous island flap for reconstruction of traumatic softtissue defects around the knee and on the proximal lower leg. Proximally based sural adiposecutaneousscar flap in. 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. The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have. Objective soft tissue injuries at the level of lower extremities, plantar, and dorsal foot pose a surgical challenge for reconstructive surgeons. Partial flap loss was found in 2 patients 8%, marginal flap necrosis in 2 patients 8% and complete loss in 1 patient 4%. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. The authors present their experience with the sural flap, also in some particular cases. Increasing the success of reverse sural flap from proximal. The medial sural artery perforator msap free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. Furthermore, the sacrifice of the sural nerve results in hyposensitivity of the lateral border of the foot.
813 1173 101 281 1240 867 120 1327 179 1197 767 379 195 1090 638 410 1555 309 469 1625 161 141 619 1383 682 325 114 205 392 1085 153 257 1241 189 1124 587 1219 1319 862 471