Background: Soft tissue defect reconstruction in foot and
ankle represents a significant challenge for the reconstructive
surgeons. The distally based sural flap provides a good option
for coverage. Its main disadvantage is the reverse venous
flow with frequent venous congestion. Many efforts made to
overcome this problem such as super draining the vein through
supercharging it to any superficial vein or intermittent drainage
by venous cannulation.
Patients and Methods: A comparative study was performed
on diabetic patients with defects on the foot and ankle at
Plastic Surgery Department, Qena University Hospital, from
May 2017 to April 2019. Twenty patients were divided into
two groups; Group (A): Defects had reconstructed with super
drainage reversed sural flap technique (10 cases) and Group
(B): Defects had reconstructed with standard reversed sural
flap technique (10 cases). They were 14 (70%) males and 6
(30%) females. Ages of them ranged from 25-65 years old
(mean 45 years). Different sites of defect sites had encountered
in the study: Heel in 15 cases (75%), ankle in 3 cases (15%)
and distal leg in 2 cases (10%).
Statistical analysis: Data was analyzed using the Statistical
Package for Social Sciences (SPSS) version 20. A p-value
<0.005 was considered significant.
Results:
• In Group (A) patients: At the second day post-operative,
two cases (20%) had slight venous congestion which not
relieved by local injection of subcutaneous heparin. A partial
flap necrosis occurred only in one of them and the other
had complete flap necrosis and flap loss (another flap
reconstruction was done). This case also showed wound
dehiscence, and graft loss at the pedicle and the donor site
areas. All other flaps showed complete healing without
complications.
• In Group (B) patient: Venous congestion occurred in seven
cases (70%) which ended in partial flap necrosis in four
cases (40%) and complete flap necrosis in three cases (30%).
Also, wound dehiscence was reported in the three cases
with complete flap loss that underwent secondary surgery
for re-stitching. Skin regrafting was performed in 2 (20%)
cases at the pedicle and the donor site area.
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The flaps usually healed eventually by 3rd week, but full
weight bearing on them postponed up to 6th week and all
patients were satisfied with the good functional and aesthetic
outcomes.
Conclusion: The distally based the sural flap is a versatile
flap for the reconstruction of soft tissue defects of the lower
leg and heel. Despite its big problem concerning the reverse
venous flow, superdrainage of the lesser saphenous vein either
by supercharging or catheterization, provides an effective
solution to keep away from venous congestion.