A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: Inclusion of a gastrocnemius muscle "cuff" around the sural pedicle

In the upper part of the leg, the sural nerve and its accompanying median superficial sural artery are buried between the two heads of the gastrocnemius muscle. Several authors found that the reverse sural artery flap was safe only if it was taken from the lower leg along the suprafascial course of the sural pedicle. This author presents a modified technique of harvesting the reverse sural artery flap from the proximal part of the leg: A midline "cuff" of gastrocnemius muscle containing the buried sural pedicle is harvested with the flap. This modification allowed maintaining a "mesenteric" connection between the sural pedicle and the overlying fascia in the upper part of the leg. A comparison between the incidence of ischemic events that occur with reverse sural artery flaps harvested using the standard and the modified techniques confirmed a more stable blood supply with the latter technique. The arterial and venous drainage of the reverse sural artery flap is discussed.