Article
Versatility of sural flap for lower member osteocutaneous injuries: revision of 40 cases
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Published: | February 6, 2020 |
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Introduction: The repair of losses of substances in the leg, ankle and foot, which are produced by high-energy trauma, are a challenge for orthopedic surgeons. For this, the reverse flow sural fascio-cutaneous flap appears as a viable and safe alternative for cutaneous coverage of substance losses or complications of traumas and fractures exposed in these regions.
Materials and Methods: In the period from January 2014 to May 2018, 40 reverse flow sural flaps were performed. Thirty-eight patients of the 40 operated on were evaluated once one patient lost the follow-up and another did not meet the inclusion-exclusion criteria, therefore, they were not considered in the analysis.
As an inclusion criterion, all patients operated on to make a reverse flow sural fascio-cutaneous flap regardless of age, gender or agent causing the lesion were considered and patients with associated pathologies such as rheumatoid arthritis, peripheral vascular diseases and the abandonment of the disease were excluded treatment.
Results: Of the 40 patients analyzed, the average time of hospitalization was 45.3 days, since all the patients were discharged from the hand surgery team after 24 hours of the procedure.
The series consisted of 32 male patients and 8 female patients with an average age of 38.9 and 31 years, respectively.
Of these patients only three were not victims of direct trauma, being hospitalized for chronic osteomyelitis, cutaneous pressure ulcer in a patient with diabetes mellitus and another derived from spinal cord injury with paraplegia.
Traumatic causes included motorcycling accidents with 17 cases, corresponding to 42%, followed by falls of height with 11 patients, corresponding to 27%, followed by road accidents, direct traumas, crushes, etc.
A total of 11 complications were identified, corresponding to 27% of the total cases, with the partial necrosis identified in 6 patients, of which four were closed by second intention and two required skin graft placements in necrosis. A case of ischemia of the flap, interpreted as a strangulation of the pedicle, had the need to reposition the flap in its normal anatomical position.
There was survival of all the flaps performed, with satisfactory coverage of the lesions despite the complications described.
Conclusion: The reverse flow sural flap, with wide fascia segment, is a useful and versatile flap that can be easily lifted to reconstruct soft tissue defects of the leg in the middle and distal third, ankle, hindfoot and foot.