Proximally Based Sural Artery Flap

Arafa, Abdel Latif; Youssef, Gamal

doi:10.21608/ejprs.2018.215086

Proximally Based Sural Artery Flap

Document Type : Original Article

Authors

Abdel Latif Arafa ¹
Gamal Youssef ²

¹ The Department of Plastic and Reconstructive Surgery, Shebin El-Kom Teaching Hospital

² The Department of Plastic and Reconstructive Surgery Sohag University

10.21608/ejprs.2018.215086

Abstract

Background: There have been few reports regarding the
proximally based sural artery flap, which is useful for reconstruction
of soft tissue defects around the knee and on the proximal
third and middle third of the leg especially in the medial aspect
of these sites.
Introduction: The proximally based sural fasciocutaneous
flap is an ideal alternative for reconstruction of soft tissue
defects around the knee and on the proximal half of the leg.
Its advantages include a thin sensate flap, good aesthetic
outcomes, and reduced donor site morbidity. However, there
have been limited reports regarding its clinical application.
Objectives: The aim of this article is to review the use of
proximally based sural flap for reconstruction of the knee
region and our experience in its application in traumatic cases
and in contracture release.
Methods: A total number of fifteen cases of proximally
based sural artery flap were done in Shebin El-Kom Teaching
Hospital and Sohag University Hospital from March 2013 to
March 2016 with age ranges from ten to forty years with
mean age was 26.9 years. Nine cases were postburn contracture
and six cases was traumatic skin loss. Follow-up was done
for at least 6 months.
Results: All flaps were survived with good functional
results and acceptable cosmetic appearance. Donor site is
covered by split thickness skin graft.
Conclusion: This proximally based sural fasciocutaneous
flap was reliable and efficient to reconstruct soft-tissue defects
around the knee and on the proximal part of the leg with more
versatility than other flaps used. The coverage for soft-tissue
defects was accepted. This flap is relatively easy to learn and
is an ideal reconstructive choice especially in the medial side
of the knee and popliteal fossa defects.

Keywords

Main Subjects

Flaps

References

1- Chengliang Deng, Zairong Wei, Bo Wang, Wenhu Jin,
Wenduo Zhang, Xiujun Tang, Bihua Wu, Guangfeng Sun
and Dali Wang: The proximally based lateral superficial
sural artery flap: A convenient and optimal technique for
the reconstruction of soft-tissue defects around the knee
Int. J. Clin. Exp. Med., 9 (8): 15167-15176, 2016.
2- Stephen J. Mathes and Foad Nahai.: Reconstructive Surgery
Principles, Anatomy & Tèchnique Sural Artery Flap. P.
1498, Churchill. Livingstone. Inc., 1997.
3- Haitao Pan, Qixin Zheng and Shuhua Yang.:Utility of
Proximally Based Sural Fasciocutaneous Flap for Knee
and Proximal Lower Leg Defects, Wounds, 26 (5): 132-
138, 2014.
4- Suri M.P., Friji M.T., Ahmad Q.G. and Yadav P.S.: Utility
of proximally based sural artery flap for lower thigh and
knee defects. Ann. Plast. Surg., 64 (4): 462-465, 2010.
5- Zheng H.P., Lin J., Zhuang Y.H. and Zhang F.H.: Convenient
coverage of soft-tissue defects around the knee by
the pedicled vastus medialis perforator flap. J. Plast.
Reconstr. Aesthet. Surg., 65 (9): 1151-1157, 2012.
6- Hong J.P. and Koshima I.: Using perforators as recipient
vessels (supermicrosurgery) for free flap reconstruction
of the knee region. Ann. Plast. Surg., 64 (3): 291-293,
2010.
7- Leclère F.M., Eggli S. and Mathys L.: Vögelin E. Anatomic
study of the superficial sural artery and its implication in
the neurocutaneous vascularized sural nerve free flap.
[Epub ahead of print March 29]. Clin. Anat. doi:
10.1002/ca.22054, 2012.
8- Zhang Y.X., Zhang Y.G., Yang J., Wang D.R. and Qian
Y.L.: Anatomy and clinical application of posterior calf
fasciocutaneous flap [in Chinese]. Zhonghua Zheng Xing
Wai Ke. Za. Zhi., 24 (3): 192-195, 2008.
9- Cheon S.J., Kim I.B., Park W.R. and Kim H.T.: The
proximally-based sural artery flap for coverage of soft
tissue defects around the knee and on the proximal third
and middle third of the lower leg: 10 patients followed
for 1-2.5 years. Acta. Orthop., 79 (3): 370-375, 2008.
10-Dai J., Chai Y., Wang C. and Wen G.: Proximal-based
saphenous neurocutaneous flaps: A novel tool for reconstructive
surgery in the proximal lower leg and knee. J.
Reconstr. Microsurg., 29 (6): 373-378, 2013.
11-Rajacic N., Gang R.K., Darweesh M., Abdul F.N. and
Kojic S.: Reconstruction of soft tissue defects around the
knee with the use of the lateral sural fasciocutaneous
artery island flap. Eur. J. Plast. Surg., 22 (1): 12-6, 1999.
Egypt, J. Plast. Reconstr. Surg., January 2018 181
12- Shim J.S. and Kim H.H.: A novel reconstruction technique
for the knee and upper one third of lower leg. J. Plast.
Reconstr. Aesthet. Surg., 59 (9): 929-34, 2006.
13-Hasegawa M., Torii S., Katoh H. and Esaki S.: The distally
based superficial sural artery flap. Plast. Reconstr. Surg.,
93 (5): 1012-20, 1994.
14-Masquelet A.C, Romana M.C. and Wolf G.: Skin island
flaps supplied by the vascular axis of the sensitive
superficial nerves: Anatomic study and clinical experience
in the leg. Plast. Reconstr. Surg., 89 (6): 1115-21, 1992.
15- Rajacic N., Darweesh M., Jayakrishnan K., Gang R.K.
and Jojic S.: The distally based superficial sural flap for
reconstruction of the lower leg and foot. Br. J. Plast.
Surg., 49 (6): 383-9, 1996.
16- Huisinga R.L., Houpt P. and Dijkstra R.: Storm van
Leeuwen J B. The distally based sural artery flap. Ann.
Plast. Surg., 41 (1): 58-65, 1998.
17- Le Fourn B., Caye N. and Pannier M.: Distally based
sural fasciomuscular flap: Anatomic study and application
for filling leg or foot defects. Plast. Reconstr. Surg., 107
(1): 67-72, 2001.
18- Sang-Jin Cheon, Bo Kim, Won-Ro, and Hui-Taek Kim:
The proximally-based sural artery flap for coverage of
soft tissue defects around the knee and on the proximal
third and middle third of the lower leg 10 patients followed
for 1-2.5 years. Acta. Orthopaedica, 79 (3): 370-
375, 2008
19- Meyer C., Hartmann B., Horas U., Kilian O., Heiss C.
and Schnettler R.: Reconstruction of the lower leg with
the sural artery flap. Langenbecks Arch. Surg., 387 (7-
8): 320-5, 2002.