gms | German Medical Science

Objectives/Interrogation: The objective of this study is to verify whether or not the sural flap can be employed to treat wounds other than the classical locations or in the presence of local risk factors for the flap's vascularity.

Methods: Between 2006 and 2016, 44 consecutive cases of sural flaps were performed in 44 patients in two universities hospitals. They were retrospectively analysed in terms of flap viability and divided into two groups according to the indication for the sural flap. Group A was comprised of 31 patients with classical indications for the sural flap such as defects located at the distal third of the leg and hindfoot and with an intact posterior leg. The flaps were elevated from the posterior aspect of the leg at the musculotendinous junction of the gastrocnemius muscle. The pivot point was planned approximately 5 cm proximal to the tip of the lateral malleolus, according to the classical description of Masquelet et al. (1992). Group B was formed by 13 patients with local risk factors that could potentially jeopardise the flap's pedicle (scarring or previous incisions located around the pivot point of the flap at the postero-lateral aspect of the leg) or to cover defects in which the sural flap is not usually indicated such as the middle third of the leg or forefoot. In these cases, the flaps were harvested from a more proximal area than usually are and the pivot point was also moved proximally to avoid scarred areas or pre-existing incisions.

Results and Conclusions: In Group A, there were 6 cases of partial flap loss (19,35%) and 2 cases of total flap loss (6,45%). In Group B, we observed only 4 cases of partial flap loss (30,76%), without any complete flap loss. There was no statistically significant difference in the occurrence of partial or total flap loss among the two groups (p= 0.73). Conclusions: The percentage of flap loss was not increased when the sural flap was used to cover more proximally or distally located wounds, even in the presence of previous incisions or scars nearby the flap's pedicle. Although partial flap loss occured quite frequently with the sural flap, it did not jeopardize the soft tissue coverage because in most instances it occured at the more distal and superficial part of the flap.