Reverse Sural Artery Pedicle Flap

Objective: To demonstrate the technical aspects of a reverse sural artery (RSA) flap. Design: Video case presentation. Setting: Community Level 2 Trauma Center. Patients: Single patient with a full thickness soft tissue loss over the posterior calcaneal tuberosity requiring soft tissue coverage. Method: Video demonstration of the stepwise planning and technical aspects of performing an RSA flap. Outcome: Successful soft tissue coverage of an exposed calcaneal tuberosity using an RSA flap. Conclusion: The RSA flap is a relatively simple fasciocutaneous flap that can be used to cover wounds of the lower leg and foot. Orthopaedic trauma surgeons can easily perform this procedure after a short time reviewing the neurovascular anatomy of the lower leg and understanding some of the important technical aspects of the procedure. This flap does not require microsurgical skills and can be done fairly quickly. The flaps usually have some partial necrosis that may require debridement, dressing changes, and surgeon patience. The main morbidity of the operation is lateral foot numbness and the need to harvest a split thickness skin graft.