ABSTRACT
The management of soft tissue defects over distal leg, ankle and heel is technically demanding procedure. Skin grafts are not suitable and donor sites for local flaps are limited: free tissue transfer needs special equipments and microsurgical team. Aim was to achieve durable coverage in simplest way, to save leg and restore function leg, ankle foot unit. This prospective study was conducted at Department of Orthopaedic Surgery, Nishtar Hospital, Multan from June 2002 to June 2005. Eleven patients with soft tissue defects of distal leg, ankle and heel which required flap coverage were included. Preoperative data was recorded and photographs taken. Modified wide base cutaneous pedicale reverse flow superficial sural artery flap was used in all patients. Skin pedicle was not tubed. Flap dimensions harvested were recorded and photograph taken. Out of eleven patients, 10 were male, one female, age ranged from 15-49 years. Eight patients had defect due to trauma, two osteomyelitis and one patient was with ischemic heel sore with exposed achillis tendon. Maximum flaps dimensions were 12.5 x 10.5 cm. postoperatively nine flaps survived completely. Two had marginal tip necrosis. Flap oedema and venous congestion occurred in 1. One patient had wound dehiscence. There were no deep infections. Three patients had non-union distal tibia, which needed another procedure. During our follow up all wounds remain stable. Wide base reverse flow superficial sural artery flap was a viable single stage reconstructive option for our patients with distal leg, ankle and heel soft tissue defects. Procedure is simple and results are satisfactory