Reverse Island Sural Flap for Lower Leg and Ankle Reconstruction

Introduction & The repair of soft tissue defect in lower leg and heel area with free flap is still a standard in reference books. However, there are disadvantages in the use of free flap like increased operative time, the damage of major vessels and the need for experienced microsurgeon. The use of local fasciocutaneous flap is usually impossible in these areas due to limited soft tissue, especially in moderate and large size defect. Reverse island sural flap is an island flap based on the vascular axis of the sural nerve, which gets reverse blood flow through communication with the perforating branch of the proneal artery in lateral malleolar gutter. This flap can be a good alternative to free flap for the reconstruction of lower leg and heel soft tissue defect. Between 1383 and 1386, 20 patients (18 male and 2 female), mean age 36 years were treated in 2 plastic and reconstructive centers for soft tissue defect of lower leg and heel area with reverse island sural flap. The mean follow up of patients was 6 months. After debridment and detection of defect size, flap was elevated. The flap was inseted in defect aria and the pedicle passed over skin in 18 patients and passed through subcutalous tunnel in 2 patients. Flap pedicel was removed after 2 months. In all patients, repair was complete, venous congestion was occurred in 16 patients. Superficial partial flap necrosis was present in 2 patients which were treated with conservative management. In 1 patient, bleeding from flap border was occurred, but stopped after 12 hours. According to the results of our study, reverse island sural flap is a good alternative to free flap for coverage of lower leg and heel soft tissue defect. Short operative time, easy technique and rapid ambulation of patient are the advantages of this flap.