Increasing the success rate of the reversed-flow fasciocutaneous island sural flap: a clinical experience in 26 cases.

The reversed-flow fasciocutaneous island sural flap is presenting one of the best reconstructive options in the distal third of the leg, around the ankle and the heel up to the metatarsals. Although the surgical maneuver of this flap and many of its modifications have been well described in previous publications, the flap is unfortunately full of reported complications. In this work, we are presenting a 26-patient series of reversed-flow fasciocutaneous island flap cases in different age, sex, and etiologic groups. All flaps had survived, with a complication rate of 3.8% (1 case) in the form of partial necrosis. In this series, we standardized a modified technique in which we tried to include many ideas and tricks, in addition to some of the reported useful ones to have a higher success rate. We have summarized these points in 10 golden rules, making this flap safer and more versatile.