Neurotized sural flap: An alternative in sensory reconstruction of the foot and ankle defects

Microsurgery ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 183-189 ◽  
Author(s):  
Onder Tan ◽  
Osman E. Aydin ◽  
Recep Demir ◽  
Ensar Z. Barin ◽  
Hakan Cinal ◽  
...  
Keyword(s):  
Foot And Ankle ◽  
Sural Flap ◽  
Sensory Reconstruction

scholarly journals Reverse Sural Flap for Repair of Foot and Ankle Defects: Our Cases, Modifications, and a Literature Review

2020 ◽  
Vol 6 ◽  
pp. 2513826X2094798
Author(s):  
Recep Anlatici
Keyword(s):  
Literature Review ◽  
Traffic Accidents ◽  
Spinal Cord Injuries ◽  
Reverse Flow ◽  
Foot And Ankle ◽  
Sural Flap ◽  
Flap Repair ◽  
Flap Monitoring ◽  
Subcutaneous Tunnel ◽  
The Mean

Introduction: Reverse-flow sural flap is a valuable option in cases of lower extremity repair. In this study, we aimed to present our sural flap applications and modifications for the treatment of ankle and foot defects and to evaluate our results in the light of historical process and current literature. Materials and Methods: A reverse-flow fasciocutaneous flap was performed in 14 patients to repair foot and ankle defects. In 6 cases (42.86%), we chose to perform interpolation sural flaps where we aimed to repair the distal defects of the foot and/or in order to prevent patients from having trouble wearing shoes due to bulkiness of the flap pedicle at the ankle. In other cases (tunnel flap group, 57.14%), the pedicle of the flap was passed through the subcutaneous tunnel. Wide and meticulous dissection of the tunnel, nitroglycerine application on the flap, and close flap monitoring were our protective measures. Our results were analyzed statistically. The literature review was performed from Medline and PubMed. Results: Sural flap repair was performed in 14 patients. The mean age was 32.75 years. Etiologic factors were traffic accidents, spinal cord injuries, and hyperkeratotic lesions. The defects were localized in the ankle or proximal foot in 12 (85.71%) patients and the distal foot in the remaining patients (14.29%). The mean area of the defects was 46.75 cm2. Partial necrosis at the distal flap developed in 2 (25%) cases in the tunnel group and in 1 (16.67%) in the interpolation group (3 cases in total, 21.43% in the study population). No statistical difference was found between the flap groups in terms of patient distribution and complications. Conclusion: Wide dissection of the subcutaneous tunnel through which the pedicle is passed (in the tunnel group), application of nitroglycerin, meticulous hemostasis, and postoperative follow-ups are important factors for a successful reverse sural flap application. Sural interpolation modification is advantageous in several cases as the flap can reach farther and does not cause bulkiness in the ankle that would impair shoe wear. However, the disadvantage is that it requires 2 sessions.

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

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.

The Distally Based Sural Flap for Foot and Ankle Reconstruction

2007 ◽  
Vol 6 (2) ◽  
pp. 118-122 ◽  
Author(s):  
Howard Levinson ◽  
Keith E. Follmar ◽  
Alessio Baccarani ◽  
Steffen P. Baumeister ◽  
Detlev Erdmann ◽  
...  
Keyword(s):  
Foot And Ankle ◽  
Sural Flap ◽  
Distally Based ◽  
Distally Based Sural Flap

Distally Based Adipofascial Sural Flap for Foot and Ankle Reconstruction

2011 ◽  
Vol 101 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Ali Mojallal ◽  
Christo D. Shipkov ◽  
Fabienne Braye ◽  
Pierre Breton
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Dorsal Side ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Sural Flap ◽  
Post Traumatic ◽  
Distally Based ◽  
Age Range

Background: This retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. Methods: Twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; age range, 17–63 years) underwent surgery between November 1, 2003, and November 30, 2008. Distally based adipofascial sural flaps were used in ten open fractures, 14 soft-tissue post-traumatic defects, and four deep burns. Defects were on the dorsal side of the foot (eight cases), the lateral malleolus (four cases), the medial malleolus and inframalleolar region (four cases), the Achilles tendon region (eight cases), and the anterior surface of the ankle (four cases). Surgical procedures were performed by a single surgeon (A.M.). Results: All of the flaps healed uneventfully. There was no partial or total flap loss. All 28 patients walked normally at the time of follow-up. Three delayed healings occurred at the donor site. Conclusions: This is a homogeneous series of lower-limb reconstructions with the distally based adipofascial sural flap, which permits better analysis of the results. This flap has a constant and reliable blood supply. It can be used for the reconstruction of nonweightbearing foot and ankle regions to avoid the bulky volume of the fasciocutaneous flap in this area and to minimize the donor site scar. (J Am Podiatr Med Assoc 101(1): 41–48, 2011)

The Distally Based Superficial Sural Flap for Reconstruction of the Foot and Ankle in Pediatric Patients

2013 ◽  
Vol 29 (03) ◽  
pp. 199-204 ◽  
Author(s):  
Lifeng Liu ◽  
Yunan Liu ◽  
Lin Zou ◽  
Zongyu Li ◽  
Xuecheng Cao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Foot And Ankle ◽  
Sural Flap ◽  
Distally Based

Distally Based Perforator Propeller Sural Flap for Foot and Ankle Reconstruction

2014 ◽  
Vol 72 (3) ◽  
pp. 340-345 ◽  
Author(s):  
Shi-Min Chang ◽  
Xin Wang ◽  
Yi-Gang Huang ◽  
Xiao-Zhong Zhu ◽  
You-Lun Tao ◽  
...  
Keyword(s):  
Foot And Ankle ◽  
Sural Flap ◽  
Distally Based

Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement

Microsurgery ◽  
2013 ◽  
Vol 33 (5) ◽  
pp. 342-349 ◽  
Author(s):  
Johnlong Tsai ◽  
Han Tsung Liao ◽  
Po Fang Wang ◽  
Chien Tzung Chen ◽  
Chih Hung Lin
Keyword(s):  
Patient Selection ◽  
Proximal Part ◽  
Foot And Ankle ◽  
Sural Flap

Soft-Tissue And Bone Tumors About The Foot And Ankle

1994 ◽  
Vol 13 (4) ◽  
pp. 909-938 ◽  
Author(s):  
Arthur K. Walling ◽  
Seth I. Gasser
Keyword(s):  
Soft Tissue ◽  
Bone Tumors ◽  
Foot And Ankle
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