Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

  • Mok, Wan Loong James (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital) ;
  • Por, Yong Chen (Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital) ;
  • Tan, Bien Keem (Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital)
  • Received : 2014.06.26
  • Accepted : 2014.08.20
  • Published : 2014.11.15
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Abstract

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

Keywords

References

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  3. Use of the cross-leg distally based sural artery flap for the reconstruction of complex lower extremity defects vol.46, pp.3, 2014, https://doi.org/10.5999/aps.2017.00892
  4. Reverse Superficial Sural Artery Flap for the Reconstruction of Soft Tissue Defect Accompanied by Fracture of the Lower Extremity vol.55, pp.3, 2014, https://doi.org/10.4055/jkoa.2020.55.3.253
  5. Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendo vol.78, pp.None, 2014, https://doi.org/10.1016/j.ijscr.2020.12.027
  6. Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps vol.37, pp.7, 2021, https://doi.org/10.1055/s-0041-1723817
  7. Reverse flow cross leg sural flap as a reconstructive option for traumatic defects in the lower leg circumventing free flaps vol.44, pp.6, 2021, https://doi.org/10.1007/s00238-021-01806-4