Comparative Study of Two Types of Distally Based Sural Neurocutaneous Flap for Reconstruction of Lower Leg, Ankle, and Heel

Background The use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps. Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016. Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p = 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p = 0.01), as was coverage failure (23.7 vs. 2.6%, p = 0.035). Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.

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Reconstruction of soft tissue defects of the lower leg with the distally based medial adipofascial flap

British Journal of Plastic Surgery ◽

10.1016/0007-1226(94)90173-2 ◽

1994 ◽

Vol 47 (2) ◽

pp. 132-137 ◽

Cited By ~ 29

Author(s):

Sin-Daw Lin ◽

Chung-Sheng Lai ◽

Chih-Kang Chou ◽

Chin-Wei Tsai ◽

Chin-Cheng Tsai

Keyword(s):

Soft Tissue ◽

Lower Leg ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Distally Based ◽

Tissue Defects

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Distally‐based sural flap for reconstruction of the lower leg and foot

Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery ◽

10.1080/02844310310010580 ◽

2004 ◽

Vol 38 (1) ◽

pp. 16-20 ◽

Cited By ~ 8

Author(s):

Hirotaka Suga ◽

Yoshio Oshima ◽

Kiyonori Harii ◽

Hirotaka Asato ◽

Akihiko Takushima

Keyword(s):

Lower Leg ◽

Sural Flap ◽

Distally Based ◽

Distally Based Sural Flap

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Lower leg reconstruction using distally based saphenous island flap

European Journal of Plastic Surgery ◽

10.1007/s002380000205 ◽

2001 ◽

Vol 24 (1) ◽

pp. 7-11 ◽

Cited By ~ 11

Author(s):

N. Rajacic ◽

R. K. Gang ◽

J. Krishnan ◽

S. Kojic

Keyword(s):

Lower Leg ◽

Island Flap ◽

Distally Based

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Consideration in Using the LSCN in Sural Flap Sensory Reconstruction: An Anatomic Evaluation

International Surgery ◽

10.9738/intsurg-d-16-00089.1 ◽

2016 ◽

Vol 101 (7-8) ◽

pp. 375-380

Author(s):

Fang Wang ◽

Lianxin Li ◽

Dongsheng Zhou ◽

Dongsheng Zhu ◽

Wensheng Li

Keyword(s):

Weight Bearing ◽

Lower Leg ◽

Cutaneous Nerve ◽

Sural Flap ◽

Communicating Branch ◽

Distally Based ◽

Protective Sensation ◽

Almost All ◽

Sensory Reconstruction ◽

Tissue Defects

The distally based or the reverse pedicle sural flap (abbreviated as the sural flap) is widely used for the coverage of soft-tissue defects in the lower leg, ankle, and foot. Clinical studies have tended to confirm that almost all the cases receiving the sural nerve (SN) anastomosed to the recipient nerve had sensory reconstruction for the weight-bearing heel in past decades. However, these results were incompletely consistent with the published anatomic literature about the variations of the SN branches in the lower legs. We conducted a clinical anatomic study to clarify some ambiguous view points in the sensory reconstruction of sural flap. Thirty-two lower legs of Chinese cadavers were dissected, and the data about distribution and variations of the SN branches were collected. The medial sural cutaneous nerve (MSCN) and the peroneal communicating branch (PCB) had no sensory subbranches to the upper and middle posterolateral surface of the lower leg except that the PCB had sensory subbranches in one leg. The lateral sural cutaneous nerve (LSCN) ramified 1 to 8 sensory subbranches to above the area in 24 of 32 (75%) legs. The LSCN is the nerve of choice for sensory reconstruction of the sural flap, anatomically; at most, about two-thirds to three-fourths (65%–75%) of the sural flap could have the sensate reconstruction via anastomosis. In contrast, the PCB nerve offers a very low possibility of reinnervation. The MSCN cannot neurotize the sural flap, although protective sensation recovery may be obtained.

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