The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot).

Soft tissue defect of the lower extremities especially over the distal third leg, ankle region, tendo achilies area, heel and foot has always been challenging for the Plastic surgeon. Though with introduction of Microsurgery, the expertise and its advances, free flap surgery to cover the defect is not possible in every center due to the sophisticated instruments, equipments and lengthy procedures. The reverse sural fasciocutaneous flap is a viable option for the soft tissue coverage of distal third leg and foot. Between Nov 2008 till Nov 2010, 11 patients with moderate size soft tissue defect (5-15 cm defect) with exposed bone, tendons and hardware of ankle joint, posterior aspect of heel, and dorsum of the hind foot and mid foot were treated with reverse sural artery fasciocutaneous flap. Out of 11 cases, 10 cases had uneventful postoperative course. In one case, we encountered complete necrosis of the flap due to venous congestion that occurred in 3rd post op day. In all other cases, the flap survived completely without any marginal necrosis. Split thickness skin graft was well taken in donor site in all other cases. The sural artery fasciocutaneous flap is versatile and reliable procedure, easy and quick to elevate, due to the long pedicle, distalization up to the dorsum of the mid foot can be achieved and also a good alternative to microsurgical procedures where such facilities are not available and the surgeon is not well familiar with the procedure.