Tunnelized reverse flow sural flap (TRSF): Case report
Keywords:
sural flap, leg reconstruction, sural nerveAbstract
Introduction: the reconstruction of defects in the distal third of the leg and foot is complex due to the exposure of critical structures. The reverse- flow sural flap (RFSF) is an effective solution that avoids sacrificing major arteries. This study reports two cases treated with tunneled RFSF. Materials and methods: two patients with peripheral arterial disease and prior revascularization were treated with tunneled RFSF. Cutaneous islands with a wide pedicle and subcutaneous tunnels were designed to prevent tension and ensure flap viability. Results: Case 1, with a 9 x 6 cm defect in the foot, was treated with a 10 x 7 cm flap. Case 2, with a 13 x 10 cm defect in the distal leg, received a 14 x 11 cm flap. In both cases, the flaps and donor site grafts showed complete viability and integration by the fifth postoperative day, allowing for early discharge without major complications. Discussion: the tunneled RFSF is effective for complex defects, as it avoids a second surgical stage, reduces complications, costs, and hospital stay, and optimizes aesthetic and functional outcomes. Conclusions: the technique is safe and efficient, making it ideal for lower extremity reconstruction.
References
1. Donski P, Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Plast Reconstr Surg. 1985;75(5):779-785.
2. Masquelet AC, Romana MC, Wolf G. Skin Island Flaps Sup- plied by the Vascular Axis of the Sensitive Superficial Nerves. Plast Reconstr Surg, 1992;89(6):1115-1121.
3. Yang D, Steven F, Morris M. Reversed sural island flap sup- plied by the lower septocutaneous perforator of the peroneal artery. Ann Plastic Surgery 2002; 49:375-378
4. Baumeister, S. P., Spierer, R., Erdmann, D., Sweis, R., Levin, L. S., & Germann, G. K. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plastic and reconstructive surgery 2003;112(1), 129-142. https://doi.org/10.1097/01.PRS.0000066167.68966.66
5.Reverse-flow sural flap: 10 years of clinical experience and modifications. Fabiel Spani Vendramin 2012;27(2). http:// www.dx.doi.org/
6.Baumeister, Steffen P et al. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plastic and reconstructive surgery jul 2003;112(1):129-40; discussion 141-2. doi:10.1097/01.PRS.0000066167.68966.66
7.Benito-Duque P., Gómez-Bravo M., de Juan-Huelves A., Mazarrasa- Marazuela B., Delgado-Giraldo P.A., Losilla-Rodríguez J.M. Modifi- caciones del colgajo sural invertido para aumentar su viabilidad en reconstrucción de grandes defectos del pie. Cirugía Plástica Ibero- Latinoamericana enero-marzo 2018; 44(1):65-73. Epub 08-Feb-2021. https://dx.doi.org/10.4321/s0376-78922018000100012
8. Tan, Onder et al. Supercharged reverse-flow sural flap: a new modification increasing the reliability of the flap. Microsurgery 2005; 25(1): 36-43. doi:10.1002/micr.20072
9. Follmar K.E., Baccarani A., Baumeister S.P., Levin L.S., Erdmann D. The Distally Based Sural Flap. Plast Reconstr Surg 2007; 119(6):138-148.
10. Benito-Duque P., Gómez-Bravo M., De Juan-Huelves A. et al. Modi- ficaciones del colgajo sural reverso para mejorar su viabilidad en la reconstrucción de grandes defectos de piel. Cir. plást. iberolatinoam. 2018;44(1):65-73.
11. Suero de la Cruz J.C., Pacheco C., Vázquez H., Hernández R., Fernández R. Modificación de la técnica de colgajo sural reverso: pedículo de amplitud total de la isla cutánea. Cir. plást. iberolatinoam. 2019;45(4):377-386.
12. Afifi A.M., Mahboub T.A., Losee J.E., Smith D.M., Khalil H.H. The reverse sural flap, modifications to improve efficacy in foot and ankle reconstruction. Ann Plast Surg 2008;61:430-436.
