Clinical Application of the Delayed Procedure in the Distally Based Sural Flap

원위기저비복피판에서 지연처치의 임상적 적용

  • Yim, Hyung-Woo (Department of Plastic and Reconstructive Surgery, College of Medicine, Eulji University Hospital) ;
  • Park, Yong-Joon (Department of Plastic and Reconstructive Surgery, College of Medicine, Eulji University Hospital)
  • 임형우 (을지대학교 의과대학 성형외과학교실) ;
  • 박용준 (을지대학교 의과대학 성형외과학교실)
  • Received : 2009.11.06
  • Accepted : 2010.04.16
  • Published : 2010.11.10

Abstract

Purpose: Reconstruction of soft tissue defects with osteomyelitis in the lower third of the leg represents a challenge to plastic surgeons. Moreover, it is more arduous in multimorbid patients. One excellent option for reconstruction of these defects is to use a delayed distally based sural flap. Methods: We successfully used delayed distally based sural flap with a two-step procedure. During the first operation, radical debridement and elevation of flap were performed. The raised flap was fixed again at the donor site. The delay period ranged from seven to ten days. Between August 2008 and July 2009, we underwent operations for five patients using this technique. The size of flap varied from $10{\times}6\;cm$ to $12{\times}14\;cm$. Results: All flaps successfully survived. Partial skin loss of the grafted site was seen in two patients but no further surgical procedure was required for wound healing. Complaints of hypoesthesia on the lateral part of the foot was observed. In a three month follow-up period, hypoesthesia was resolved spontaneously. Conclusion: Delayed procedure improves the viability of distally based sural flap in high risk, critically multimorbid patients. We recommend that, if a two-stage operative approach is required, the delayed procedure should be considered.

Keywords

References

  1. Hasegawa M, Torii S, Katoh H, Esaki S: The distally based superficial sural artery flap. Plast Reconstr Surg 93: 1012, 1994 https://doi.org/10.1097/00006534-199404001-00016
  2. Fodor L, Horesh Z, Lerner A, Ramon Y, Peled IJ, Ullmann Y: The distally based sural musculoneurocutaneous flap for treatment of distal tibial osteomyelitis. Plast Reconstr Surg 119: 2127, 2007 https://doi.org/10.1097/01.prs.0000260596.43001.05
  3. Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D: The distally based sural flap. Plast Reconstr Surg 119: 138, 2007 https://doi.org/10.1097/01.prs.0000259203.79909.7e
  4. Kneser U, Bach AD, Polykandriotis E, Kopp J, Horch RE: Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast Reconstr Surg 116: 1910, 2005 https://doi.org/10.1097/01.prs.0000189204.71906.c2
  5. Dhar SC, Taylor GI: The delay phenomenon: the story unfolds. Plast Reconstr Surg 104: 2079, 1999 https://doi.org/10.1097/00006534-199912000-00021
  6. Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK: A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 112: 129, 2003 https://doi.org/10.1097/01.PRS.0000066167.68966.66
  7. Ponten B: The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34: 215, 1981 https://doi.org/10.1016/S0007-1226(81)80097-5
  8. Donski PK, Fogdestam I: Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Reconstr Surg 17: 191, 1983 https://doi.org/10.3109/02844318309013118
  9. Masquelet AC, Romana MC, 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: 1115, 1992 https://doi.org/10.1097/00006534-199206000-00018