Ramesha Kt1, Prakashkumar Mn2, Shankarappa M3. 1. Associate Professor, Department of Plastic Surgery, Bangalore Medical College and Research Institute , Bangalore, India . 2. Resident, Department of Plastic Surgery, Bangalore Medical College and Research Institute , Bangalore, India . 3. Professor and Head of Department, Department of Plastic Surgery, Bangalore Medical College and Research Institute , Bangalore, India .
Abstract
BACKGROUND: One of the challenges in reconstructive surgeries, faced by a majority of surgeons, is the soft tissue defect management around the lower-third of the leg, plantar and dorsal feet. Due to the sensitive location and other related difficulties, only limited options are available in this region. A durable flap is the preferred option for coverage of such defects. OBJECTIVE: To evaluate the safety, success and efficacy of the extended reverse sural artery flap which was harvested, with extension to proximal-third of the leg. METHODOLOGY: This prospective study was conducted at Department of Plastic Surgery, on 18 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested medium to large sized reverse sural artery flaps with extensions to the upper third of the calf, to cover the defects found in the distal tibia, ankle, heel, foot, and sole. RESULTS: A majority of flaps provided a good coverage for defects. Two cases developed marginal necrosis of flaps in the distal border, which was treated with use of secondary skin grafts. Four flaps developed venous congestions. In other patients, minor complications such as rupture of suture inset, development of ulcer over insensate flap, since only one patient developed ulcer and another one patient developed inset rupture and graft loss occurred. In 16 cases, the final outcome was unaffected by any complications. CONCLUSIONS: Extension of reverse sural artery flap to the proximal third of the leg was safe and reliable and it was efficiently used to treat patients with large and far wounds of distal leg, foot and sole.
BACKGROUND: One of the challenges in reconstructive surgeries, faced by a majority of surgeons, is the soft tissue defect management around the lower-third of the leg, plantar and dorsal feet. Due to the sensitive location and other related difficulties, only limited options are available in this region. A durable flap is the preferred option for coverage of such defects. OBJECTIVE: To evaluate the safety, success and efficacy of the extended reverse sural artery flap which was harvested, with extension to proximal-third of the leg. METHODOLOGY: This prospective study was conducted at Department of Plastic Surgery, on 18 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested medium to large sized reverse sural artery flaps with extensions to the upper third of the calf, to cover the defects found in the distal tibia, ankle, heel, foot, and sole. RESULTS: A majority of flaps provided a good coverage for defects. Two cases developed marginal necrosis of flaps in the distal border, which was treated with use of secondary skin grafts. Four flaps developed venous congestions. In other patients, minor complications such as rupture of suture inset, development of ulcer over insensate flap, since only one patient developed ulcer and another one patient developed inset rupture and graft loss occurred. In 16 cases, the final outcome was unaffected by any complications. CONCLUSIONS: Extension of reverse sural artery flap to the proximal third of the leg was safe and reliable and it was efficiently used to treat patients with large and far wounds of distal leg, foot and sole.