Reverse Superficial Sural artery flap for the Reconstruction of Soft Tissue Defect on Posterior side of heel exposing Achilles tendon

PURPOSE: Soft tissue defect on posterior side of heel exposing Achilles tendon is vulnerable and require thin flap to improve aesthetic and functional results. Reverse superficial sural artery flap is simple and fast procedure, and it can preserves major arteries, supplies reliable constant blood, causes less donor site complication. Authors reviewed our cases and report the clinical results. MATERIALS AND METHODS: Nine cases of soft tissue defects on the posterior side of heel exposing Achilles tendon were treated with distally based superficial sural artery flap. There were 6 male and 3 female and mean age was 48.4 years. The size of flap was from 4x4 cm to 10x15 cm and mean follow-up period was 23 months. Flap survival, postoperative complications were evaluated. RESULTS: All flaps were survived completely without necrosis. There was one case of partial wound dehiscence that needed debridement and repair, and other one case had recurrent discharge that was healed after removal of calcaneal plate. All patient showed acceptable range of ankle motion. CONCLUSION: Authors suggest that the reverse superficial sural artery flap could be one of the useful treatment options for the soft tissue defect on posterior side of heel exposing Achilles tendon.

The Effects of Modified Design of the Reverse Superficial Sural Artery Flap / 대한정형외과학회잡지

PURPOSE: To access the efficacy of a modified design of a reverse superficial sural artery flap (RSSAF) to decrease the level of venous congestion and flap necrosis. MATERIALS AND METHODS: Twenty four cases of RSSAF were performed. The mean age of the patients was 47 years and the mean follow up period was 21 months. The average size of the flap was 7.4x5.2 cm. There were 19 cases of the modified flap design and 5 cases of non-modified design. The venous congestion and complications were analyzed according to the modification of the flap design. RESULTS: The flap survived in 23 cases. Primary closure of the donor site was performed in 11 cases whose flap width was <5 cm, and 12 cases required a skin graft. Venous congestion was observed in 5 cases including 4 cases, who were not treated with the modified design and 1 case with arterosclerosis obliterans preoperatively. Partial flap necrosis occurred in 2 flaps that did not have the modified design. CONCLUSION: The modified RSSAF with a skin extension over the pedicle to decrease the tension of the tunnel is an effective procedure for reconstructing the lower extremity, which can prevent venous congestion and improve the survival rate of the flap.