Reverse flow cross leg sural flap as a reconstructive option for traumatic defects in the lower leg circumventing free flaps

The resilience of distally based sural fascio cutaneous flap in soft-tissue defects of lower limb and ankle: a prospective study

BACKGROUND

Managing large soft-tissue defects in the distal lower extremities remains challenging for orthopedic surgeons, particularly in elderly patients with comorbidities. This study evaluates the clinical outcomes of the reverse sural flap (RSF) for reconstructing soft-tissue defects in the distal leg, heel, foot, and ankle.

METHODS

This prospective study was performed on 52 cases aged from 18 to 60 years old, with either post-traumatic or post-surgical soft tissue defects situated between the distal third leg and the mid-metatarsals of the foot and underwent RSF surgery.

RESULTS

The mean hospital stay was 8.4 (± 3.24) days. All patients experienced the healing of their soft tissue coverage. During the follow-up, ten patients had complications: Ankle stiffness occurred in 2 (3.85%) patients, marginal necrosis in 2 (3.85%) patients, superficial infection occurred in 2 (3.85%) and delayed healing in 4 (7.69%) patients.

CONCLUSION

The RSF is a reliable and practical option for reconstructing significant and distal soft tissue defects in the lower extremities, with acceptable complication rates and surgical durations. Complications were found in 10 cases in the form of ankle stiffness occurring in 2 (3.85%) patients; marginal necrosis occurred in 2 (3.85%), superficial infection occurred in 2 (3.85%) patients managed with dressing, debridement, delayed healing occurred in 4 (7.69%) patients and. The hospital stay's mean value (± SD) was 8.4 (± 3.24) days.

Use of reverse sural artery cross leg flap for limb salvage in low resource setting: A case report and literature review

INTRODUCTION

Soft tissue defect in the lower limb presents as a difficult reconstructive challenge. Cross-leg flap was routinely used in the past for the salvage of the lower limb but is seldom used nowadays due to advances in microsurgical procedures.

CASE PRESENTATION

We present a case of an 18-year-old male who presented with a complex soft tissue defect of 25 × 10 cm on the anterolateral aspect of the right leg following a motor vehicle accident. The defect was unsuitable for local flaps due to the unavailability of healthy tissue or free tissue transfer as no suitable recipient vessels were available for microvascular anastomosis in the vicinity. After serial debridement, the patient was planned for a distal cross-leg fasciocutaneous sural artery flap from the left leg to cover the defect. The cross-leg flap was elevated over the posterior aspect of the left leg with 2 delay procedures over 2 weeks and inset was done over the defect with an intact pedicle. External fixators were applied to fix the legs in a cross-leg position. Finally, the flap was detached after 3 weeks.

DISCUSSION

Cross-leg flap has a clear role in reconstructive trauma surgery because of its simplicity, good-quality coverage, and minimal cosmetic disadvantage. We, therefore, advise its application in cases when microvascular competence or operating room time is limited, or the injury is not suitable for local tissue transfer.

CONCLUSION

A pedicled cross-extremity flap can be successfully employed for the salvage of the limb in a resource-limited setting.