The distally based superficial sural artery island flap: Clinical experiences and modifications

The coverage of defects of the Achilles tendon, malleoli, and heel remains a challenge to reconstructive surgeons. The distally based superficial sura l artery island flap is vascularized by the median superficial sural artery , posterolateral septal perforators originating from the peroneal artery, n eurovascular arteries of the sural nerve, and combinations of these systems as suprafascial plexus. We used distally based superficial sural artery is land flaps for the reconstruction of defects of ankle, malleolus, and heel in 17 patients between 1991 and 1997. The largest flap we have used until t oday was 12 cm in width and 15 cm in length. All flaps have survived. Howev er, we observed venous congestion and edema in two flaps. Also, marginal ne crosis occurred in two flaps for which we had not taken the sural nerve wit h the flap. After these complications, we made some modifications. We left a skin extension over the fasciovascular pedicle and used it as a roof of t he tunnel. We took the sural nerve and the deep fascia in all cases. The ma in advantage of this flap is a constant and reliable blood supply without s acrifice of a major artery. In addition, this is a one-stage, safe and easy procedure that can be used for large defects.