Evaluation of the versatility of increasing proximal limit of distally based reversed sural fasciocutaneous flap for soft tissue coverage of foot and ankle area

Aldabaany, Waleed; Elghamry, Ashraf H.; Abdeltawab, Mahmoud; Yassin, Mohamed

doi:10.21608/ejsur.2024.330302.1249

Evaluation of the versatility of increasing proximal limit of distally based reversed sural fasciocutaneous flap for soft tissue coverage of foot and ankle area

Document Type : Original Article

Authors

Department of Plastic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

10.21608/ejsur.2024.330302.1249

Abstract

Background: Addressing soft-tissue injuries in the distal parts of the foot and ankle continues to be a complex issue
for reconstructive and trauma surgeons. Management strategies encompass local fasciocutaneous flaps, pedicled muscle
flaps, and microsurgical free-flap. The distal pivot of the sural fasciocutaneous flap was crafted at the most inferior
septocutaneous perforator, originating from the peroneal artery in the posterolateral septum. This point typically sits 5cm
(range, 4–7cm) above the tip of the lateral malleolus. In this research, we aim to evaluate the reverse sural flap versatility
when we raise it to 5cm above the line of junction between the upper third and the lower two thirds of the leg.
Patients and Methods: This is a prospective randomized study. The study was approved by the local ethics committee.
This study included 20 patients with complicated wounds over the heel and the foot treated by a distally based reversed
sural fasciocutaneous flap with increasing its proximal limits.
Results: G The mean age among the study group was 42±10.4 years and ranged between 25 and 60 years, with 85% being males versus 15% being females. The mean patient satisfaction score was 8.5±0.95. There was a statistically significantly higher level of distal congestion, necrosis, and viable necrosis flap among cases with proximal extension 5cm and with a P value of 0.02. There was a statistically significant sensitivity to proximal extension in the diagnosis of distal necrosis of 71.4% and a specificity of 85.6% at the cutoff value 3.5 with a P value of 0.008.
Conclusion: We could conclude that increasing the proximal limits up to 2cm above the middle one-third of the calf is very safe, while increasing the proximal limits more than 2cm may have risks regarding distal flap necrosis and congestion.

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