Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Basis and a Retrospectively Study of 378 Flap Clinical Series

2021 ◽  
Author(s):  
Ling-Li Zhou ◽  
Jian-Wei Wei ◽  
Ping Peng ◽  
Li-Hong Liu ◽  
Chao-Dong Yin ◽  
...  
Keyword(s):  
Sural Nerve ◽  
Anatomical Variation ◽  
Point Group ◽  
Lower Limbs ◽  
Sural Flap ◽  
Pivot Point ◽  
Partial Necrosis ◽  
Clinical Series ◽  
Neurocutaneous Flap ◽  
Distally Based

Abstract Background This study is to describe the distribution of natural true anastomoses associated with the distally based perforator-plus sural neurocutaneous flap (sural flap), summarize our experience in the flap with high pivot point, and compare the outcomes between the flaps with high and low pivot points. Methods Five amputated lower limbs were perfused, and the integuments were radiographed. We retrospectively analyzed 378 flaps, which were divided into two groups: pivot points located ≤8.0 cm (low pivot point group) and >8.0 cm (high pivot point group) proximal to the tip of the lateral malleolus. Partial necrosis rates were compared between two groups. Results The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. True anastomoses existed among peroneal perforators and between these perforators and the arterial chain. There were 93 flaps with high pivot point and 285 flaps with low pivot point. Partial necrosis rates were 16 and 9.1% in the high and low pivot point group (p = 0.059), respectively. Conclusion True anastomosis connections among peroneal perforators and the whole arterial chain around sural nerve enable the sural flap to survive with a greater length. The sural flap with high pivot point is a good option for reconstructing soft-tissue defects in the middle and distal leg, ankle, and foot, particularly when the lowest peroneal perforator presents damage, greater distance to the defects, discontinuity with the donor site, or anatomical variation.

A Retrospective Study of an Updated and Traditional Surgical Approach of the Distally Based Sural Flap

2020 ◽  
Author(s):  
Heng Xu ◽  
Xuexin Cao ◽  
Sally Kiu-Huen ◽  
Zhu Zhu ◽  
Jun Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Traditional Approach ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Lateral Malleolus ◽  
Sural Flap ◽  
Pivot Point ◽  
Propeller Flap ◽  
Distally Based ◽  
Distally Based Sural Flap

Abstract Background The distally based sural flap (DBSF) is one of the armamentarium in the lower limb reconstruction. However, the flap has not gained popularity due to concerns about its reliability and donor site morbidity. Based on the anatomy characterization, we combined and developed five modifications to improve the vascular supply and reduce donor site morbidity. Patients and Methods The authors performed a comparison of retrospective study that included patients who underwent either traditional distally based sural flap (tDBSF) or modified distally based sural flap (mDBSF) surgery approach for ankle, heel, and dorsal foot coverage between January 2007 and May, 2019. The five modifications developed to improve the reliability of the flap include: 1. shift the pivot point more proximally 7.0 cm above the lateral malleolus, 2. preserve the lesser saphenous vein and include branches that communicates with the flap, 3. harvest thinner fascial pedicle, 4. change the skin incision to “S” shape, 5. closure of the donor site with a propeller flap. Results Thirty-one patients underwent mDBSF, and 23 received tDBSF. There were no significant differences in the size of the DBSF. Mean pedicle width was significantly narrower in mDBSF (1.63 ± 0.52 cm vs. 3.81 ± 0.70 in tDBSF). The pivot point was also found to be higher in mDBSF (8.01 ± 0.63 cm vs. 5.46 ± 0.56 cm) above the lateral malleolus. In mDBSF, the size of the propeller flap required for donor site closure was 53.45 ± 19.06 cm2 (range 33–80 cm2). The rate of partial necrosis between mDBSF and tDBSF was significantly different (9.68 vs. 34.78%). While the other complications had no difference. Conclusion The modifications applied to the harvesting of the DBSF have achieved higher survival rate, lower dehiscence rate, and shorter hospital stay time in comparison with traditional approach in our retrospective study.

scholarly journals Unusual anatomical variation in formation of sural nerve

2019 ◽  
Vol 18 (3) ◽  
pp. 508-512
Author(s):  
Humberto Ferreira Arquez
Keyword(s):  
Lower Limb ◽  
Sural Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Anatomical Variation ◽  
Medical Science ◽  
Common Peroneal Nerve ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Cutaneous Nerve

Background: Sural nerve is formed by communication of medial sural cutaneous nerve, that arise from tibial nerve in popliteal fossa and peroneal communicating nerve, a branch directly from common peroneal nerve or from lateral sural cutaneous nerve.The objective of this study was described an unusual and few reported anatomical variation in formation of sural nerve. Materials and Methods: The anatomical variation described was found during routine dissection performed by medical students of second semester in two maleembalbed adult cadavers of 75 and 65 years of age, respectivelyin the laboratory of Morphology of the University of Pamplona. Results and Discussion: In the left lower limb, both medial sural cutaneous nerve, and lateral sural cutaneous nervewere absent. The sural nerve arose directly from the tibial nerve. It’s observed a communicating branch between tibial nerve and common peroneal nerve. In the right lower limb, lateral sural cutaneous nerve was absent. The sural nerve arose directly from the common peroneal nerve.Peroneal communicating nerve was considered as absent in the two cases.Motor fiber from sural nerve to gastrocnemius muscle was observed in both lower limbs Conclusions:The knowledge of the sural nerve (normal anatomy and variations in origin and course) is important in evaluating of the patients, as well explaining the different clinical findings necessary for accuracy treatment. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.508-512

scholarly journals Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhaobiao Luo ◽  
Jiangdong Ni ◽  
Guohua Lv ◽  
Jianwei Wei ◽  
Lihong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Donor Site ◽  
Width Ratio ◽  
Partial Necrosis ◽  
Paediatric Patients ◽  
Skin Island ◽  
Potential Risk Factors ◽  
Lower Extremity Reconstruction ◽  
Distally Based

Abstract Background No large series have analysed distally based sural fasciocutaneous (DBSF) flaps in paediatric patients. The aims of this study were to assess the reliability and analyse the potential risk factors for these flaps and to describe complications in the donor site and the functional follow-up results. Methods Between June 2002 and November 2017, 88 DBSF flaps were used to reconstruct soft tissue defects in paediatric patients. Potential risk factors, reconstruction outcomes, and complications in the donor site of the flaps were analysed. Results Among the 88 flaps, partial necrosis developed in 8 flaps (9.1%). The partial necrosis rate was significantly higher in flaps with the top edge located in the 9th zone (26.1%), with a length-width ratio (LWR) ≥ 5:1 (28.6%), and with a dimension of the skin island ≥ 100 cm2 (22.7%). Partial necrosis did not occur in flaps with a dimension of the skin island < 80.0 cm2 or with a skin-island width < 7.0 cm. The reconstruction outcomes in most paediatric patients were evaluated as “excellent” or “good”. The incidence of obvious scarring was higher in the donor site. Conclusions Partial necrosis of DBSF flaps will significantly increase when the top edge of the flap is located in the 9th zone, when the LWR of the flap is ≥ 5:1, or when the dimension of the skin island is ≥ 100.0 cm2. Flaps with a skin-island width < 7.0 cm or with a dimension of the skin island < 80 cm2 are relatively safe and reliable.

The Distally Based Sural Flap

2007 ◽  
Vol 119 (6) ◽  
pp. 138e-148e ◽  
Author(s):  
Keith E. Follmar ◽  
Alessio Baccarani ◽  
Steffen P. Baumeister ◽  
L Scott Levin ◽  
Detlev Erdmann
Keyword(s):  
Sural Flap ◽  
Distally Based ◽  
Distally Based Sural Flap

scholarly journals Distally Based Sural Flap in Children: Reliability Technique

2021 ◽  
Vol 3 (5) ◽  
pp. 29-31
Author(s):  
A. Benjelloun ◽  
N. Belmoudden ◽  
M. Habla ◽  
M. Benkhaldoun ◽  
A. Elharti ◽  
...  
Keyword(s):  
Functional Result ◽  
Vascular Complications ◽  
Sural Flap ◽  
Good Functional Result ◽  
Distally Based ◽  
The Aesthetic ◽  
Distally Based Sural Flap

The distally based sural flap often poses the problem of venous suffering that can lead to necrosis. We present a reconstruction of a loss of substance of the ankle in a 6 years old child, using a distal pedicle sural flap, made reliable by a racket like flap method, which reduces the risk of vascular complications and led to good integration of the flap, with a good functional result. Nevertheless, the aesthetic sequelae remain significant.

scholarly journals Caso Clínico: Cirugía Reconstructiva de Tobillo

2018 ◽  
Vol 10 (2) ◽  
pp. 170-174
Author(s):  
Fulvio Enrique Zuñiga Cabrera ◽  
Jaime Santiago Clavijo Jaramillo ◽  
Adriana Abigail Guzmán Villa
Keyword(s):  
Diabetes Mellitus ◽  
Reverse Flow ◽  
Public Health Problem ◽  
Lower Limbs ◽  
World Health ◽  
Major Public Health Problem ◽  
Sural Flap ◽  
Advantages And Disadvantages ◽  
Left Ankle ◽  
Osteosynthesis Material

BACKGROUND: Diabetes mellitus is a major public health problem, according to the World Health Organization, 422 million adults worldwide in 2014. In 2012, it caused 1.5 million deaths worldwide. Diabetes is the leading cause of non-traumatic amputation in lower limbs and foot infections occur with high frequency in poorly controlled patients. This case shows the reconstruction of soft tissue defects in the lower third leg, heel, malleoli and foot through the description of the reverse sural flap. In this study the advantages and disadvantages of the use of this technique are discussed. CASE REPORT: A 56-year-old female patient with a poorly controlled history of Diabetes Mellitus type 2, who suffered a fracture of the left ankle treated with osteosynthesis, and who during the postoperative period attended emergency orthopedics and traumatology, due to severe pain in the left ankle, fever, dehiscence of surgical wound, accompanied by serous secretion. EVOLUTION: The patient, after several surgical cleanings and changes in closure therapy assisted by negative pressure, manages to control the infection, with persistence of the bone coverage defect and the osteosynthesis material. There were additional complications such as joint stiffness, muscle atrophy; it was decided to reconstruct the distal third of the foot using a reverse flow sural fasciocutaneous flap, which evolved satisfactorily, managing to cover the defect with biological tissue. CONCLUSIONS: The sural flap of reverse flow is a reproducible technique that allows to cover coverage defects in the distal third of the leg and ankle; shorten hospitalization times, especially when there is bone exposure or osteosynthesis material.

Anatomy of the sural nerve and its relation to the Achilles Tendon

2000 ◽  
Vol 21 (6) ◽  
pp. 475-477 ◽  
Author(s):  
Jonathan Webb ◽  
Narain Moorjani ◽  
Mike Radford
Keyword(s):  
Achilles Tendon ◽  
Nerve Injury ◽  
Individual Variation ◽  
Sural Nerve ◽  
Proximal Part ◽  
Lower Limbs ◽  
Lateral Border

Sural nerve injury is a complication of Achilles Tendon (TA) rupture. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the TA. At the level of insertion of the TA into the calcaneum, the sural nerve was a mean 18.8 mm from the lateral border of the TA. The proximal course of the nerve was towards the midline such that it crossed the lateral border of the TA at a mean distance of 9.8 cm from the calcaneum. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Percutaneous sutures should not be placed in the lateral half of the TA.

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