How Safe Is Reverse Sural Flap? A Systematic Review

Sanjib Tripathee, MD; Surendra Jung Basnet, MD; Apar Lamichhane, MCH; Lynda Hariani, PhD

Disclosures

ePlasty. 2022;22(18) 

In This Article

Abstract and Introduction

Abstract

Background: Soft tissue reconstruction of the lower third of the leg, the ankle, and the foot is challenging for reconstructive surgeons. The options for reconstruction are limited. Reverse sural flap is relatively easy to perform and considered a good option for reconstruction. The complication rates are variable in studies. This study aims to systemically review all available articles based on reverse sural flap focusing on complications of the flap. The overall complication of the flap helps to better understand the reliability of the flap.

Methods: A comprehensive literature search was performed using MEDLINE, EMBASE, and Google Scholar to identify cases of reverse sural artery flap.

Results: A pooled analysis of 89 articles was performed, which yielded 2575 patients (2592 flaps) over a period of 19 years. Most of the cases were performed in Asian countries (1540 flaps, 59.4%) with the majority being performed in China (746 flaps, 28.8%). The most common cause for reverse sural flap surgery was trauma/postsurgical (1785/2592) followed by burn/scarring. Flap complications were recorded in 653 of 2592 flaps (25.20%). The most common complication was partial flap loss, which was recorded in 204 flaps (7.85%) followed by venous congestion (79 flaps, 3.05%). Complete flap loss was observed only in 66 participants (2.5% of all the flaps performed).

Conclusions: Reverse sural flap is reliable flap for the reconstruction of lower leg, ankle, and foot. It can give a comparable outcome as free flap when meticulously performed and, in many cases, a better result.

Introduction

Soft tissue reconstruction of the lower third of the leg and the foot is challenging for reconstructive surgeons. The major problem is limited mobility of the skin and poor vascularity. Various methods of reconstruction have been described for reconstruction such as local flap, free flap, perforator flap, etc. The distally based sural fasciocutaneous flap is a good option for the reconstruction of the lower third of the leg and the foot. The major advantage of this flap is that it does not require microsurgical skills and can be done in a minimal-resource center. The first distally based sural fasciocutaneous flap was defined by Donski et al in 1983 for Achilles tendon coverage.[1] The detailed anatomy of distally based sural fasciocutaneous flap for the reconstruction of distal third of leg, foot, and ankle defect was described by Masquelet et al in 1992.[2] Later, various modifications were illustrated by other studies.[3–5]

The distally based sural fasciocutaneous flap is the workhorse flap for many reconstructive surgeons, especially when they lack microsurgical skills or when other reconstructive options are not available. Many surgeons believe the sural flap is a good alternative to the free flap. The complication rates are variable in studies. This study aims to systemically review all available articles based on the reverse sural flap, focusing on complications of the flap. Knowing the overall complications of the flap helps us to better understand the reliability of the flap. Furthermore, this study reviews the demographics and etiologies for flap surgery.

processing....