A modified technique for transposition of the reverse sural artery flap

Background: Coverage of a soft-tissue defect of the lower third of the leg is a difficult problem. The reverse sural artery flap, first described by Masquelet, is a random type of flap, based on the superficial sural artery. Methods: We treated 10 patients with 11 reverse sural artery flaps. A modification of flap transposition through a subcutaneous tunnel with the aid of a soft-tissue expander was described to prevent venous congestion, especially in longer tunnels, for flap insetting. Results: Eight flaps survived completely. Distal tip and partial skin necrosis was observed in three flaps in two diabetic patients (27.2 percent). No venous congestion was observed after this modification. Conclusion: The reverse sural artery flap is a reliable alternative for small to moderate size defects and can be used with modifications of the original technique.