Reconstruction of the Soft Tissue Defect of the Lower Leg by Distally Based Superficial Sural Artery Flap Using the Endoscope

ABSTRACT

A soft-tissue defect of lower one third of the leg presents a challenging problem because of the tightness and poor circulation of the skin. Various forms of coverage, including muscle flaps, facial flaps, septocutaneous flaps, axial flaps, and free flaps, have their own specific indications and inherent disadvantages. The distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. Up to now, distally based superficial sural artery flap has some disadvantages such as postoperative flap edema, congestion, partial necrosis of the flap margin and unfavorable scar. However, we could decrease these disadvantages by means of endoscopy. When subcutaneous fascial pedicle dissected includes sural nerve, superficial sural artery and small saphenous vein, the endoscope offers the magnified view, and enables us to dissect them more easily and safely. We report 2 cases of endoscopic surgery with some references concerning the defect of soft tissue in distal area of lower extremity and ankle joint using distally based superficial sural artery flap without complication.