Distally Based Sural Artery Flap: A Workhorse to Cover the Soft Tissue Defects of Distal Leg, Ankle and Foot

Distal leg, ankle and foot injuries are relatively common; and because of lack of soft tissue and poor blood supply in these areas, one of the common problems in these patients is soft tissue necrosis. Exposed orthopedic implants can be used as open reduction internal fixator (ORIF) in these regions.
During 2013-2014, 14 patients (11 men and 3 women) with a mean age of 30 years were enrolled the study in the Department of Plastic and Reconstructive Surgery, Shafa Hospital, Kerman, Iran. All the patients were referred from the Department of Orthopedic Surgery because of exposed orthopedic implants. The minimum and maximum size of the defects was 3 × 5 and 11 × 15 cm, respectively. 7 defects were in distal leg, 3 in foot, 2 in ankle and 2 in distal leg and ankle together. After measuring the defect, sural flap based on sural artery and nerve was prepared and transferred with a rotation of 180 degrees to the defect site over the exposed orthopedic implants, before the separation.
In all 14 patients, the healing was complete. In 2 cases, we had to remove the prostheses because of infection and in 3 cases, partial necrosis was seen; and in 4 cases, a hypertrophic scar was seen in donor site and a neurosensorial deficit was seen in the sural nerve sensory areas. But in all of them, the sural flap was successful and there was no need to replace this flap to another one.
Due to the good clinical results, sural flap can be a viable alternative to cover the exposed prostheses of distal leg, ankle and foot.