A Clinical Study on Islanded Reverse Sural Artery Flap for the Reconstruction of Defects over the Lower Third of Leg and Foot PC01-PC06
Dr. Surya Rao Rao Venkata Mahipathy,
Professor, Department of Plastic and Reconstructive Surgery, Saveetha Medical College and Hospital,
Thandalam, Kanchipuram, Chennai-602105, Tamil Nadu, India.
Introduction: The islanded reverse sural artery flap is a versatile, relatively simple procedure, useful in reconstruction of lower third leg, heel, tendo achilles region, malleoli and hind foot defects because of the long vascular pedicle. The surgical technique is safe, of short duration and provides alternative to microsurgical reconstruction.
Aim: To study the versatility and applications of islanded reverse sural artery flaps in the reconstruction of distal third leg, heel and foot defects.
Materials and Methods: A prospective study was conducted between October 2007 to March 2010, 26 patients with moderate sized skin and soft tissue defects in the distal third of leg and foot were treated with Islanded Reverse Sural Artery Flap at Government Chengalpattu Medical College, Tamil Nadu, India. The flap was planned in reverse, after marking with Doppler and procedure was performed. Factors like size of defect, length and width of pedicle, comorbid factors and complications were taken into account for the study.
Results: Most of the flaps were done on post traumatic defects. Around 80% of the flaps had settled well with no or minimal donor site morbidity. Increasing age, co-morbid factors, narrow pedicle and arc of rotation of about 180 degrees all caused an increased complication rate which varied from 10 to 38%.
Conclusion: Islanded reverse sural artery flap with its wide arc of rotation can provide cover to lower third of leg, heel and foot defects, thereby, reducing the need for staged cross leg flap and other flaps. It is a reliable and versatile flap in the hands of reconstructive surgeon to provide good quality skin cover for defects of the leg and foot with acceptable donor site morbidity in a single stage.