Distally Based Sural Fasciocutaneous Flap and Cross-leg Method for Soft Tissue Reconstruction of the Distal Leg, Ankle, and Hind Foot Defects

Abstract

This paper presents the authors' experience of using cross-leg and direct sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. All surgeries were performed during 2010-2014. This nonrandomized descriptive prospective and retrospective study recruited 25 patients which consisted of 19 patients with direct sural fasciocutaneous flaps (age: 20-49 years) and six with cross-leg, indirect sural fasciocutaneous flaps (age: 6-48 years). The follow-up period ranged between six months - three years. The defects were located on calcaneus, malleolar area, tarsal area, and lower tibia. Out of 25 flaps, 22 showed complete survival (88). Partial flap loss was found in five patients (20) and complete loss in three patients (12), including one (16.7) using the cross- leg method and two (10.5) using the ipsilateral flap. Out of 19 patients who underwent ipsilateral RSAFs, five patients had flap tip necrosis (< 10 flap area). Two of these patients were subjected to flap readvancement and reinsertion and three patients were managed with regular dressings. In one case, a superficial necrosis occurred and skin graft was required. The sural fasciocutaneous flap, even its cross-leg form, is useful for the treatment of severe and complex injuries and their complications in lower limbs. This type of flap offers excellent donor sites for repairing soft tissue defects in foot and ankle and distal leg.