The understanding of the skins vascular anatomy has improved in the last decade. Case series of sural island flaps used for softtissue. Distallybased sural island flap for soft tissue coverage. The sural island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and softtissue defects in chronic osteomyelitis of the tibia. Superficial sural artery neurocutaneous flap is an island flap based on vascular axis of sural nerve which gets reverse vascular. Materials and methods included in this study were all the sural flaps that were. Distallybased sural island flap can be performed as a onestep procedure without sacrifice of any major artery. Aug 11, 2009 an defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap.
The distally based island sural flap was outlined at the junction of the two heads of g the astrocnemius muscle. The reverse sural island flap should no longer be regarded as a flap of. The use of sural island musculo fasciocutaneous flap, in. Dissections of 20 legs showed that in the majority the lateral sural cutaneous artery branched from the popliteal artery and descended along the posterolateral aspect of the leg together with two venae comitantes and the lateral sural cutaneous nerve. The flap is vascularized by the lowermost perforating branches of the peroneal artery. Figure 2 distally based fasciocutaneous island flap for lateral malleolus coverage. It is reliable, safe and should be the choice for reconstruction of ankle and heel defects. A large skin island was marked along the axis of the sural nerve figure 2. Reverse sural island flap in coverage of defects lower. The flap consists of superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery. The objective of this study was to evaluate the efficacy of distally based sural flap. Reverseflow islanded sural flap can be used for reconstructiing a large area, e. Utility of proximally based sural fasciocutaneous flap for. Xiaohua li1,2,3, huidong wang2, chunlin xia1, lei zhuang3,shimin chang3, baozhi ding2, zelu li3 1department of anatomy and boxi institute of clinical anatomy, medical college of soochow university, suzhou.
The reverse flow sural flap has been featured as a relevant option for recons truction of the. Objective to investigate the anatomic foundation of using main branch of posterior femoral nerve to restore the sensation function of distal based sural island flap. Reverse flow sural flap al azhar assiut medical journal. Surgical anatomy of the medial sural artery perforator flap wong et al. Distally based suralis fasciocutaneous flap in the armamentarium of the orthopaedic trauma surgeon int j cur res rev, jan 2014 vol 06 01 page 54 the distally based sural artery flap, first described as a distally based neuro cutaneous flap by masquelet et al. To establish the sural island fasciocutaneous flap as an initial consideration for distal third lowerextremity soft tissue coverage and to provide nonplastic surgeons with a procedure they can perform on their own.
The sural artery flap is contraindicated in patients with destruction of the vascular pedicle or the lowermost perforator of the peroneal artery see table 292. Since then, many studies have been performed on anatomical and clinical aspects of this flap, which was commonly referred to as reverse sural artery island flap and has become an acceptable and routine technique for lower limb reconstruction. This technique had not been mentioned in the literature before as far as we know. The distally based sural neurovenofasciocutaneous island flap was developed by masquelet et al and has been widely used for distal leg, ankle, achilles tendon, and foot defect reconstruction. The sural artery island flap in salvage of a prosthetic. To establish the sural island fasciocutaneous flap as an initial consideration for distal third lowerextremity soft tissue coverage and to provide nonplastic surgeons with a procedure. The reverse sural island flap should no longer be regarded as a flap of secondary choice to free tissue transfer, but as an equally valuable alternative for small and midsized defects around the ankle and heel. This is a random type of flap, based on the reverse flow of the superficial sural artery, which mainly depends on the anatomy of the perforators of the. 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 type a fasciocutaneous flap based on the sural artery direct cutaneous branch of the popliteal artery. A total of 71 patients were operated on with this technique, some of them with. Sural is one of the leading manufacturers of wire, and aluminum bars used for mechanical applications and welding. A successful island type flap design, in the early group.
Commentary on distally based sural neurofasciocutaneous. Distally based sural neurofasciocutaneous island flap to. We then assessed our case series of sural island flaps from. The proximally based lateral superficial sural artery flap. Pdf the distally based island superficial sural artery. Distally based perforator sural flaps for foot and ankle. Distally based sural island flap for foot and ankle. Read commentary on distally based sural neurofasciocutaneous island flap to cover tissue loss in the distal third of the leg by parodi et al. The distallybased sural artery flap, is a skin island flap supplied by vascular axis of sural nerve.
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. This flap provides a solution that can be effectively used for various reconstructions in the distal third of the lower extremity, thus offering a valid alternative to solutions involving. Distally based sural island flap for the reconstruction of. Original article fasciocutaneous sural nerve flap for lower extremity reconstruction. Pdf acute vascular complication following sural flap. Small superficial defects of the lower onethird of the leg can be treated by a sural artery flap if the defect size is smaller than 6. The operative technique is very well described in previous publications. The distally based superficial sural artery flap, first described as a distally based neuroskin flap by masquelet et al. Almost the entire posterior leg can be used for obtaining the sural flap base, when surgical delay is involved. The flap is vascularized by the lowermost perforating branches of the peroneal. Salvage of the distal foot using the distally based sural. Pdf the distally based island superficial sural artery flap. Pdf on jan 1, 2020, sokol isaraj and others published reconstruction of defects of the lower third of the leg and foot with a reverse sural island. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply.
Reverse sural flap for ankle and heel soft tissues. A distally based fasciocutaneous island flap from the lateral sural region was used to solve the problem. A line of incision was traced over the presumed course of the sural nerve and the lesser saphenous vein. Furthermore, the sacrifice of the sural nerve results in hyposensitivity of the lateral border of the foot. The distally based superficial sural flap for reconstruction of the. Reverse sural flap for ankle and heel soft tissues reconstruction ncbi. The distally based sural island flap is vascularized by the cutaneous perforating branches of the peroneal artery. The reverse flow island sural flap is presented as an alternative to flaps currently. Harvest of distally based fasciocutaneous island flap from the lateral sural region with a wide adipofascial pedicle. Dec 31, 2016 the reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel.
The flap consists of superficial and deep fascia, the sural. The reverse superficial sural artery flap revisited for complex. To investigate the blood supply and clinical application of reverse island flap pedicled with sural nerve and its nutrient vessels. Soft tissue reconstruction of the foot using the distally. Versatility of delayed reverseflow islanded sural flap for reconstructing pretibal defects among highrisk patients. Jan 18, 2019 the medial sural artery perforator flap was originally heralded as a promising thin free flap donor site, most ideal for the ipsilateral distal lower extremity. Jun, 2016 the sural artery flap is insensate and is not an option in cases in which sensitivity is an issue. At this point, the island flap including the skin, subcutaneous tissue, and the deep fascial tissues containing the neurovascular structures, are elevated off the surface of the gastrocnemius muscle. It is located between the popliteal fossa and the midposterior leg between the medial and lateral heads of the gastrocnemius muscle. A distally based fasciocutaneous island flap from the lateral sural region was used to.
Sural founded in 1975 is a world leader in the technology of continuous casting and rolling of aluminum and its alloys. Pdf reconstruction of defects of the lower third of the. Since amarante described a distally based fasciocutaneous flap of the leg in 1986 and masquelet described a flap based on the vascular axis of the sural nerve, the sural artery fasciocutaneous flap has come to be a reliable flap for defects around the ankle. The reverse superficial sural artery flap revisited for. Figure 6 a a 22yearold male presented with a left foot degloving. A successful islandtype flap design, in the early group. Original article fasciocutaneous sural nerve flap for lower. The sural artery island flap in salvage of a prosthetic ankle. However, this flaps versatility allows for the limits of its indications to be increased to include multiple areas of the posterior lower limb with small defects. To overcome this, we have modified our operative technique, which has produced a more reliable flap. A crossleg flap or free flap offer the possibility of salvaging the limb, but has the associated difficulties of immobilisation and positioning of the extremities from the time of initial coverage to detachment. This is a random type of flap, based on the reverse. An islandtype reverse superficial sural artery flap rssaf was used for coverage of the wound.
Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee. Pdf reconstruction of defects of the lower third of the leg. Pdf on jan 1, 2020, sokol isaraj and others published reconstruction of defects of the lower third of the leg and foot with a reverse sural island flap find, read and cite all the research you. Versatility of delayed reverseflow islanded sural flap. Pressure ulcer over the lateral malleolus in a 60yearold male patient. Three variants of this flap were used for reconstruction of 19 patients with defects in the ankle and in both dorsal and plantar surfaces of the foot. The reverse sural artery flap is utilized to reconstruct defects in the distal third of the lower leg, ankle, and heel. This paper describes a flap for covering defects around the knee. This flap is based on perforators of the peroneal artery system. The most common location for transposition of the reverse sural flap is to the posterior heel and distal lateral malleolus. The pivotal point of the pedicle was three fingers breadth proximal to the tip of the lateral malleolus. Because of its potentially long vascular pedicle based on the medial sural vessels, reach as an island flap not requiring a microanastomosis for knee coverage is another asset.
The medial sural artery perforator flap was originally heralded as a promising thin free flap donor site, most ideal for the ipsilateral distal lower extremity. Such flaps are based on the cutaneous branches of the vascular axis around a superficial sensory nerve. Figure 8 reverse flow sural flap in an island with the graft over. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels.
A 60yearold paraplegic male suffered a pressure ulcer over the lateral malleolus of his left leg for 6 mo. Distallybased sural island flap for soft tissue coverage of. The distally based superficial sural artery flap for. The flap was distally based, islanded and covered the area with vascularised. Reverse sural island flap in coverage of defects lower third. An island type reverse superficial sural artery flap rssaf was used for coverage of the wound. The distally based sural flap, first described by masquelet et al9 in 1992 as a neurocutaneous island flap, is another option for coverage of lower of leg, ankle and foot defects. The reverse superficial sural artery flap revisited for comp.
Versatility of delayed reverseflow islanded sural flap for. A the lateral malleolar defect after debridement, showing exposed tendon and fibula defect. Three variants of this flap were used for reconstruction of 19 patients with defects in the ankle and in both dorsal and plantar surfaces of. Distally based sural island flap for the reconstruction of a. 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 distally based sural neurofasciocutaneous flap is based on the vascular contribution furnished by the arterial network that accompanies the sural nerve and on its neurocutaneous perforating branches. May, 2003 the distally based sural neurofasciocutaneous flap is based on the vascular contribution furnished by the arterial network that accompanies the sural nerve and on its neurocutaneous perforating branches. The clinical outcome of perforator based sural artery and propeller. A 20yearold man with a lateral malleolar defect and fibular fracture from a motocross accident. Lateral sural cutaneous artery island flap in the treatment.
Is it safe to extract the reverse sural artery flap from the. The distally based superficial sural artery flap for coverage. Sep 22, 2015 a successful island type flap design, in the early group. Soft tissue defects around the ankle present a major challenge to reconstructive surgeons. Surgical anatomy of the medial sural artery perforator flap.
Distally based sural faciocutaneous and fascial adipofascial. The reverse superficial sural artery flap rssaf is a popular option for many of these difficult wounds. Survivability of the flap was not affected by the island shape of the flap. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia. The distally based island superficial sural artery flap. The authors describe their additional experience with the distally based sural island flap for reconstruction of the whole foot, including the forefoot area in 8 patients. This flap provides a solution that can be effectively used for various reconstructions in the distal third of the lower extremity, thus offering a valid. An island flap was designed, pedicled on these vessels and nerve, and was used in 17 patients with defects around the knee, including acute trauma three. The use of sural island musculo fasciocutaneous flap, in the. Acute vascular complications flap necrosis and congestion. Proximally based sural adiposecutaneousscar flap in. The medial sural artery perforator island flap as a. Patients were positioned prone or lateral and a tourniquet was.
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