Versatile distally based neurocutaneous saphenous flap in the era of microsurgery
- 60 Downloads
The reconstruction of soft tissue defects in the distal third of the leg and ankle joint remains a challenge for reconstructive surgeons. Presently, the distally based neurocutaneous flaps are the predominant surgical alternatives to free tissue transfer. In this article, we describe our experience with the distally based saphenous neurocutaneous flap for reconstructing soft tissue defects in this region.
A retrospective review of all patients who underwent reconstruction of the leg distal third and ankle joint at our department from January 1996 to June 2016 was carried out. Only patients who underwent reconstructive surgery for acute traumatic injuries were included. The fasciocutaneous pedicle was 3–4 cm wide, and the anatomical structures consisted of the superficial and deep fascia, saphenous nerve, greater saphenous vein and their accompanying vessels together with an islet of subcutaneous cellular tissue and skin. The size of skin islands ranged from 5–7 to 10–14 cm2.
A total of 170 patients (142 men and 28 women) were included in this study. The mean follow-up period was 3 months. All flaps survived with partial necrosis in three patients. Severe venous congestion occurred only in five patients. However, the flap was eventually salvaged after limb elevation and interrupted bloodletting. All donor sites were closed using split-skin grafting.
The reverse saphenous neurocutaneous flap proved to be a reliable and efficient method for reconstructing soft tissue defects in the distal third of the leg and ankle joint.
Level of Evidence: Level IV, therapeutic study
KeywordsPedicled flap Distal third-leg defects Reverse saphenous flap Cross-leg flap Neurocutaneous flap
Compliance with ethical standards
There was no funding from either public, private or third-sector sources.
Conflict of interest
Pradeep Goil, Ghisulal Choudhary, Rakesh Jain, Manohar malviya and Ayush Jain declare that they have no conflict of interest.
Patients provided written consent before their inclusion in this study.
For this kind of retrospective study, formal consent from a local ethics committee is not required.
- 11.Kansal S, Goil P, Agarwal V et al (2014) Reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap for reconstruction of lower leg and foot. Eur J OrthopSurgTraumatol 24:62–72Google Scholar
- 13.Hu XH, Du WL, Chen Z et al (2013) The application of distally pedicled peroneus brevis muscle flaps and retrograde neurocutaneous accompanying artery flaps for treatment of bony and soft-tissue 3-dimensional defects of the lower leg and foot. Int J Low Extrem Wounds 12:53–62CrossRefPubMedGoogle Scholar
- 14.Chung YJ, Kim G, Sohn BK (2002) Reconstruction of a lower extremity soft-tissue defect using the gastrocnemius musculoadipofascial flap. Ann Plast Surg 49:91–95Google Scholar
- 15.Kim TG, Kim IK, Kim YH et al (2012) Reconstruction of lower extremity complex wounds with combined free tissue transfer using the anterolateral thigh flap as a link. Microsurgery 32:575–579Google Scholar
- 23.Satoh K, Aoyama R, Onizuka T (1993) Comparative study of reverse flow island flaps in the lower extremities-peroneal, anterior tibial, and posterior tibial island flaps in 25 patients. Ann Plast Surg 30:48–56Google Scholar
- 24.Tharayil J, Patil RK (2012) Reverse peroneal artery flap for large defects of ankle and foot: a reliable reconstructive technique. Indian J Plast Surg 45:45–52Google Scholar
- 25.Chang SM, Zhang K, Li HF et al (2009) Distally based sural fascio-myocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel. Microsurgery 29:205–213Google Scholar
- 26.Bocchi A, Merelli S, Morellini A et al (2000) Reverse fasciosubcutaneous flap versus distally pedicled sural island flap: two elective methods for distal-third leg reconstruction. Ann Plast Surg 45:284–291Google Scholar
- 27.Yu AX, Deng K, Tao S et al (2007) Anatomic study and clinical application of distally-based neuro-myocutaneous compound flaps in the leg. Microsurgery 27:528–532Google Scholar
- 28.Boriani F, Bruschi S, Fraccalvieri M et al (2010) Leg perforators and leg length: an anatomic study focusing on topography and angiogenesis. Clin Anat 23:593–605Google Scholar
- 29.Bhattacharya V, Reddy GR (2006) Retrograde perforator-based cross-leg fasciocutaneous flaps for distal leg and foot defects. Plast Reconstr Surg 117:1662–1664Google Scholar
- 30.Sharma RK, Kola G (1992) Cross leg posterior tibial artery fasciocutaneous island flap for reconstruction of lower leg defects. Br J Plast Surg 45:62–65Google Scholar