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초록
Purpose:
Soft tissue defects in the distal lower extremity represent a special challenge for reconstructive surgeons. Vari-ous methods of lower-limb wound coverage have been described, such as local flaps, distant flaps, and free flaps. Among various methods, the delayed reverse sural flap can be one of the several options for the reconstruction of distal lower extremity in high-risk patients. We report our experiences with the versatile, delayed reverse sural flap for coverage of the distal lower extremity in high-risk patients.
Methods:
From September 2015 to October 2016, seven patients with soft tissue defects of the distal lower extremity were treated with the delayed reverse sural flap based on a two-step procedure. All patients had significant medical co-morbidities, such as diabetes mellitus, peripheral arterial disease, and smoking. The delay period ranged from 10 to 14 days, and the flap size was from 7.5×2.0 to 14.5×4.0 cm.
REFERENCES
1.McCraw JB. Selection of alternative local flaps in the leg and foot. Clin Plast Surg. 1979. 6:227–46.
2.Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981. 34:215–20.
3.Serafin D., Georgiade NG., Smith DH. Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot. Plast Reconstr Surg. 1977. 59:492–9.
4.Singh S., Naasan A. Use of distally based superficial sural island artery flaps in acute open fractures of the lower leg. Ann Plast Surg. 2001. 47:505–10.
5.Price MF., Capizzi PJ., Watterson PA., Lettieri S. Reverse sural artery flap: caveats for success. Ann Plast Surg. 2002. 48:496–504.
6.Benito-Ruiz J., Yoon T., Guisantes-Pintos E., Monner J., Serra-Renom JM. Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Ann Plast Surg. 2004. 52:380–4.
7.Donski PK., Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Scand J Plast Reconstr Surg. 1983. 17:191–6.
8.Masquelet AC., Romana MC., Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg. 1992. 89:1115–21.
9.Parrett BM., Pribaz JJ., Matros E., Przylecki W., Sampson CE., Orgill DP. Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction. Plast Reconstr Surg. 2009. 123:1499–504.
10.Baumeister SP., Spierer R., Erdmann D., Sweis R., Levin LS., Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg. 2003. 112:129–40. discussion 141-2.
11.Tosun Z., Ozkan A., Karaçor Z., Savaci N. Delaying the reverse sural flap provides predictable results for compli-cated wounds in diabetic foot. Ann Plast Surg. 2005. 55:169–73.
12.Kneser U., Bach AD., Polykandriotis E., Kopp J., Horch RE. Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast Reconstr Surg. 2005. 116:1910–7.
13.Erdmann D., Gottlieb N., Humphrey JS., Le TC., Bruno W., Levin LS. Sural flap delay procedure: a preliminary report. Ann Plast Surg. 2005. 54:562–5.
14.Ríos-Luna A., Villanueva-Martínez M., Fahandezh-Saddi H., Villanueva-Lopez F., del Cerro-Gutiérrez M. Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb. Injury. 2007. 38:824–31.
15.Ahmed SK., Fung BK., Ip WY., Fok M., Chow SP. The versatile reverse flow sural artery neurocutaneous flap: a case series and review of literature. J Orthop Surg Res. 2008. 3:15.
16.Cavadas PC., Bonanad E. Reverse-flow sural island flap in the varicose leg. Plast Reconstr Surg. 1996. 98:901–2.
17.Angelats J., Albert LT. Sural nerve neurocutaneous cross-foot flap. Ann Plast Surg. 1984. 13:239–42.
18.Follmar KE., Baccarani A., Baumeister SP., Levin LS., Erdmann D. The distally based sural flap. Plast Reconstr Surg. 2007. 119:138e–48e.
19.Goldminz D., Bennett RG. Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol. 1991. 127:1012–5.
20.Ellsworth WA., Colon GA. Management of medical mor-bidities and risk factors before surgery: smoking, diabetes, and other complicating factors. Semin Plast Surg. 2006. 20:205–13.
21.Zheng H., Liu J., Dai X., Schilling AF. The distally based sural flap for the reconstruction of ankle and foot defects in pediatric patients. Ann Plast Surg. 2016. 77:97–101.
22.Tu YK., Ueng SW., Yeh WL., Wang KC. Reconstruction of ankle and heel defects by a modified wide-base reverse sural flap. J Trauma. 1999. 47:82–8.
23.Ramesha KT., Prakashkumar MN., Shankarappa M. Ex-tended reverse sural artery flap's safety, success and ef-ficacy: a prospective study. J Clin Diagn Res. 2014. 8:NC08–11.
24.Thawerani S., Ansari MNUR., Siddiqui N. Minimizing complications in reverse sural artery flaps. Pak J Surg. 2011. 27:2–7.
25.Gideroglu K., Yildirim S., Akan M., Akoz T. Immediate use of medicinal leeches to salvage venous congested reverse pedicled neurocutaneous flaps. Scand J Plast Reconstr Surg Hand Surg. 2003. 37:277–82.
Fig.1.
A case of posterior ankle defect. (A) Defect with exposure of the Achilles tendon. (B) Appearance at 1 week after 2nd stage of operation. (C) Appearance at 6 months postoperatively.
Fig.2.
A case of heel defect. (A) Defect with exposure of the calcaneus. (B) Intraoperative photograph; the lesser saphenous vein (black arrow) and the sural nerve (white arrow) were identified in the pedicle. (C) Appearance immediately after 2nd stage of operation. (D) Appearance at 2 days after 2nd stage of operation. Venous congestion was seen. (E) Appearance at 15 months postoperatively.
Fig.3.
A case of lateral malleolar defect. (A) Defect with exposure of the lateral malleolus. (B) Appearance immediately after 2nd stage of operation. (C) Appearance at 2 months postoperatively.
Table 1.
Summary of patient characteristics
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