The one- and two-stage distally pedicled sural flap. Surgical technique and clinical results

Background. The distally pedicled suralis flap is used to cover local defects of the distal lower leg, ankle and hind foot. It is a local flap with no need for microvascular anastomosis, a constant blood supply and ease of elevation. Disadvantages are lack of sensation, donor site morbidity and venous congestion. Methods and material. This study includes 25 patients. Apart from the defect extent, cause and location, complications were also determined. Results. The defect site was located in the hind foot in 5 cases and the distal lower leg in 14 cases. In four patients the soft tissue of the lateral calcaneal region and in two cases the sole of the foot were affected. Severe venous congestion, which was only detected in 180A degrees turned flaps, was seen in five cases. In five patients we successfully performed a two-stage flap transposition procedure to avoid venous congestion. Conclusion. The sural flap remains a reliable solution for soft tissue defects. Under inappropriate circumstances (small pedicle or severe torque of pedicle) venous congestion or even thrombosis is possible. A two-stage approach with conditioning of venous drainage can have a positive effect on these problems.