Distally Based Superficial Sural Fasciomusculocutaneous Flap: A Reliable Solution for Distal Lower Extremity Reconstruction

ABSTRACT

The objective of this study is to present a simple and rapid approach to elevate a consistent superficial sural fasciomusculocutaneous flap and show its clinical applications. All the patients with lower limb defects who underwent reconstruction using the distally based fasciomusculocutaneous sural flap were included in the study. The flap was elevated with a cuff of gastrocnemius muscle under the skin paddle, and the distal pedicle was dissected until 5 cm over the lateral malleolus. The donor site is primarily closed or skin-grafted. From March 2004 to August 2006, this distally based superficial sural fasciomusculocutaneous flap was applied to nine patients. All the defects resulted from traumatic injuries of the distal third of the leg, ankle, or foot, combined with bone or tendon exposure. Two flaps developed minor distal skin necrosis that recovered uneventfully with conservative therapy. The other flaps had an adequate postoperative evolution with good blood supply, contour, and function. The superficial sural fasciomusculocutaneous flap is a simple and consistent alternative for distal lower limb reconstruction, particularly when microsurgery is not available.

KEYWORDS

Distal lower extremity - sural flap - fasciomusculocutaneous

REFERENCES

• 1 Masquelet A C, Romana M C, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg.  Plast Reconstr Surg. 1992;  89 1115-1121
• 2 Le Fourn B, Caye N, Pannier M. Distally based sural fasciomuscular flap: anatomic study and application for filling leg or foot defects.  Plast Reconstr Surg. 2001;  107 67-72
• 3 Rajendra Prasad J S, Chaudhari C, Cunha-Gomes D et al.. The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous flap: case reports.  Br J Plast Surg. 2002;  55 210-214
• 4 Thione A, Valdatta L, Buoro M et al.. The medial sural artery perforators: anatomic basis for a surgical plan.  Ann Plast Surg. 2004;  53 250-255
• 5 Hallock G G. Anatomic basis of the gastrocnemius perforator-based flap.  Ann Plast Surg. 2001;  47 517-522
• 6 Hallock G G, Sano K. The medial sural medial gastrocnemius perforator free flap: an “ideal” prone position skin flap.  Ann Plast Surg. 2004;  52 184-187
• 7 Sladjana U Z, Ivan J D, Ljiljana V P et al.. Neurovascular stalk of the superficial sural flap: human fetus anatomical study.  Plast Reconstr Surg. 2005;  116 546-550
• 8 Magden A O, Menderes A, Yilmiz M, Barutcu M. Anatomical study of the origin and course of the median superficial sural artery.  Eur J Plast Surg. 1996;  19 29-32
• 9 Nakajima H, Imanishi N, Fukuzumi S et al.. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap.  Plast Reconstr Surg. 1998;  102 779-791
• 10 Nakajima H, Imanishi N, Fukuzumi S et al.. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications.  Plast Reconstr Surg. 1999;  103 104-120
• 11 Coert J H, Dellon A L. Clinical implications of the surgical anatomy of the sural nerve.  Plast Reconstr Surg. 1994;  94 850-855
• 12 Chen S L, Chen T M, Chou T D et al.. The distally based lesser saphenous venofasciocutaneous flap for ankle and heel reconstruction.  Plast Reconstr Surg. 2002;  110 1664-1672
• 13 Rajendra Prasad J S, Cunha-Gomes D, Chaudhari C et al.. The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous and muscle flaps: anatomical basis of a new concept.  Br J Plast Surg. 2002;  55 203-209
• 14 Mueller J E, Ilchmann T, Lowatscheff T. The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture.  Arch Orthop Trauma Surg. 2001;  121 350-352
• 15 Chen S L, Chen T M, Chou T D et al.. Distally based sural fasciomusculocutaneous flap for chronic calcaneal osteomyelitis in diabetic patients.  Ann Plast Surg. 2005;  54 44-48
• 16 Al-Qattan M M. Lower-limb reconstruction utilizing the reverse sural artery flap-gastrocnemius muscle cuff technique.  Ann Plast Surg. 2005;  55 174-178
• 17 Malokov S, Casanova D, Magalon G, Branchereau A. Sural flap vascularization in arteritic patients: an anatomic study of 24 amputation specimens.  Surg Radiol Anat. 2003;  25 372-378
• 18 Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds.  Plast Reconstr Surg. 2002;  110 1673-1679
• 19 Chen S L, Chen T M, Wang H J. The distally based sural fasciomusculocutaneous flap for foot reconstruction.  J Plast Reconstr Aesthet Surg. 2006;  59 846-855
• 20 Al-Qattan M M. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle “cuff” around the sural pedicle.  Ann Plast Surg. 2001;  47 269-274 , discussion 274–278
• 21 Zhang F H, Chang S M, Lin S Q et al.. Modified distally based sural neuro-veno-fasciocutaneous flap: anatomical study and clinical applications.  Microsurgery. 2005;  25 543-550