Article
Distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction: surgical modifications for flap pedicle and donor site closure without skin graft
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Published: | February 6, 2020 |
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Objectives/Interrogation: The conventional procedure of distally based sural neuro-fasciocutaneous flap enables the blood supply and venous drainage by increasing the width of the adipofascial tissue and preserving tiny venous return routes. Moreover, skin graft is a common method for donor site closure, which may influence the aesthetic appearance. The purpose of the study is to modify the pedicle of the flap and to design a relaying flap for the donor site closure without skin graft.
Methods: 12 patients undergoing the modified distally based sural neuro-fasciocutaneous perforator flap for foot and ankle reconstruction were included in this study. The surgical modification for flap pedicle is described. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve should be included in the pedicle. A Z-shape skin incision was used to explore the perforator vessels and a relaying island perforator flap was used to close the donor site without skin graft. Flap survival, complications, flap swelling degree and aesthetic satisfaction were evaluated. The links between the perforator vessels and the accompanying vascular axis around sural nerve were verified in 8 fresh cadavers.
Results and Conclusions: The linking vessels were constant occurrence in 8 cadavers and 12 cases during operation. All flaps survived completely without necrosis. Neither arterial ischemia nor venous congestion was noted. The diameter width and the length of the pedicle ranged from 1.0 to 2.0 cm and 4 to 10 cm, respectively. A relaying perforator island flap was used in 8 cases for donor site closure and no skin graft was performed. No serious donor site complications happened and all patients were satisfied with the aesthetic outcomes at the final follow-up.
The modification for the pedicle of the distally based sural neuro-fasciocutaneous perforator flap is considered as a reliable method for foot and ankle reconstruction. A relaying flap for the donor site closure without skin graft should be recommended.