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Subject Area

Dermatology

Article Type

Original Study

Abstract

Objective To evaluate the safety of harvesting reverse-flow sural flap from the proximal one-third of the leg with the inclusion of a part of the gastrocnemius muscle with its mesentery and with the inclusion of the mesentery only. Background The reversed sural artery flap in standard technique is usually not harvested from the proximal third of the leg. Conversely, this study is conducted to evaluate the efficiency, safety, and success of reversed sural flap harvested from the proximal third of the leg even without the inclusion of the gastrocnemius muscle. Patients and methods This study included 32 patients presented with soft tissue loss of the leg or foot, from January 2015 to January 2018 with a follow-up period of 6 months. The cases were divided into two groups: group A included 17 patients, where a part of the gastrocnemius muscle and its mesentery was involved in the flap, and group B included 15 patients, where the flap was devoid of the muscle completely. Results Postoperative splinting by plaster of Paris with a bridge over the pedicle and the full length of the flap to avoid pressure over the flap was done. In group A, two patients had full-thickness tip necrosis, where one of them required debridement and skin grafting; two patient had superficial epidermolysis of the flap, which passed unnoticed; three patients had venous congestion; and six patients had donor site scarring. In group B, one patient had marginal tip necrosis, which required skin grafting later on; two patients had venous congestion; one patient had suture rupture; and two patients had donor site scarring. Conclusion The reversed sural flap can be harvested safely from proximal one-third of the leg without harvesting a part of gastrocnemius with the flap.

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