Abstract
Aim: The aim of this retrospective study was to evaluate the clinical results of the efficacy of a modification in the venous circulation of the distal pedicled sural flap so as to diminish the venous congestion. Materials and Methods: Fifteen patients presenting with tissue defects in the distal half of the leg were reconstructed with distal pedicled sural flaps. In 10 out of 15 patients, the sural flaps were preexpanded before transposition. The lesser saphenous vein was ligated at the proximal end of the flap before entering the pedicle and distal end of the vein was also anastomosed to a superficial leg vein to improve the venous congestion in the flap. The patients were followed up for 32 months postoperatively. Results: Partial flap necrosis was observed in the first patient of the series where a venous anastomosis was not performed, despite the vein ligation in the proximal entry to the flap. In the remaining 14 patients where a venous anastomosis was performed no flap necrosis was observed. Conclusion: Venous congestion is the main factor leading to partial or total flap necrosis in distally based sural flaps. If the lesser saphenous vein is ligated before entry to the pedicle, the venous blood of the foot could not enter the flap, but still venous congestion could ocur in flap circulation. To improve the venous congestion an additional veous anastomosis between the lesser saphenous vein and a superficial vein around the recipient area a natural venous return could be facilitated and potential complications could be avoided.
References
- Rothenberger J, Krauss S, Held M, et al. Assessment of sural flap microcirculation: Which position maintains the optimal perfusion? J Plast Reconstr Aesthet Surg 2016;69(4):538-44.
- Lee HI, Ha SH, Yu SO, Park MJ, Chae SH, Lee GJ. Reverse sural artery island flap with skin extension along the pedicle. J Foot Ankle Surg 2016;55(3):470-5.
- Sugg KB, Schaub TA, Concannon MJ, Cederna PS, Brown DL. The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction. Plast Reconstr Surg Glob Open 2015;3(9):e519.
- Mohammadkhah N, Motamed S, Hosseini SN, et al. Complex technique of large sural flap: An alternative option for free flap in large defect of the traumatized foot. Acta Med Iran 2011;49(4):195-200.
- Muppireddy S, Srikanth R. Distally based reverse sural artery flap as an interpolation flap. Int J Res Orthop 2017;3(1):61-5.
- Ebrahiem AA, Manas RK, Vinagre G. Distally based sural artery peroneus flap (DBSPF) for foot and ankle reconstruction. Plast Reconstr Surg Glob Open 2017;5(4):e1276.
- Yilmaz M, Karatas O, Barutcu A.The distally based superficial sural artery island flap: Clinical experiences and modifications. Plast Reconstr Surg 1998;102(7):2358-67.
- Howard L, Keith EF, Alessio B, Steffen PB, Detlev E, Levin SL. The distally based sural flap for foot and ankle reconstruction. Tech Foot Ankle Surg 2007; 6(2):118-22.
- Park JK, Kim KY, Kim SH, Choi J, Yang JY. Versatility of delayed reverse sural flap for reconstruction of the distal lower extremity in high-risk patients. Arch Hand Microsurg 2017;22(4):280-7.
- Chang SM, Gu YD, Li JF. Comparison of different managements of large superficial veins in distally based fasciocutaneous flaps with a veno-neuro-adipofascial pedicle: An experimental study using a rabbit model. Microsurgery 2003;23(6):555-60.
- Wong CH, Tan BK. Intermittent short saphenous vein phlebotomy: an effective technique of relieving venouscongestion in the distally based sural artery flap. Ann Plast Surg 2007;58(3):303-7.
- Tan O, Atik B, Bekerecioglu M. Supercharged reverse-flow sural flap: A new modification increasing the reliability of the flap. Microsurgery 2005;25(1):36-43.
- Adel MT, Ahmed AH, Mohamed AN, Hazem ET. Distally based sural artery flap: Simple measures to ıncrease versatility and reduce complications. J Plast Reconstr Surg 2014;38(1):63-9.
- Herlin C, Sinna R, Hamoui M, Canovas F, Captier G, Chaput B. Distal lower extremity coverage by distally based sural flaps: Methods to increase their vascular reliability. Ann Chir Plast Esthet 2017;62(1):45-54.
- 15. Zhang FH, Chang SM, Lin SQ, et al. Modified distally based sural neuro-veno-fasciocutaneous flap: Anatomical study and clinical applications. Microsurgery 2005;25(7):543-50.
- Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994;93(5):1012-20.
- Mok WL, Por YC, Tan BK. Distally based sural artery adipofascial flap based on single sural nerve branch: Anatomy and clinical applications. Arch Plast Surg 2014;41(6):709-15.
- Chang SM, Li XH, Gu YD. Distally based perforator sural flaps for foot and ankle reconstruction. World J Orthop 2015;6(3):322-30.
Abstract
Amaç: Bu retrospektif çalışmanın amacı, distal pediküllü sural fleplerde venöz konjesyonu önlemek için venöz dolaşımda yapılan modifikasyonun klinik sonuçlarını değerlendirmektir. Gereç ve Yöntem: Araştırmada, 1/2 distal bacakta doku defekti olan toplam 15 hasta ameliyat edildi. Hastaların 10’unda ekspande edilmiş, 5’inde ise ekspande edilmemiş distal pediküllü sural flep kullanıldı. Venöz konjesyonu önlemek için lesser sapheneous vein (LSV) flebin distal ucunda alıcı alandaki yüzeyel bir vene anastomoz edildi ve flebin proksimalinde pedikül içine girmeden bağlandı. Hastalar postoperatif 32 ay takip edildi. Bulgular: Venöz anastomoz yapılmayan ilk vakada venöz konjesyon gelişti. Aralıklı flebotomi yapılmasına rağmen konjesyon giderilemedi ve flepte kısmi nekroz gelişti. Venöz anastomoz yapılan 14 vakada ise venöz konjesyon ve flep kaybı gibi herhangi bir komplikasyon gelişmedi. Sonuç: Ters akımlı sural fleplerde venöz konjesyon kısmi ya da total flep kaybı gibi komplikasyonlarının başlıca nedenidir. LSV pediküle girmeden bağlanırsa flep proksimalindeki dokuların (ayak) venöz kanı flep içine giremeyecektir. Buna ek olarak, alıcı alan çevresindeki bir yüzeyel ven ile LSV arasında anastomoz yapılırsa anterograd yani doğal bir venöz dönüş sağlanacaktır. Doğal bir venöz dönüş sağlandığı için venöz konjesyon ve buna bağlı komplikasyonlar da gelişmeyecektir.
References
- Rothenberger J, Krauss S, Held M, et al. Assessment of sural flap microcirculation: Which position maintains the optimal perfusion? J Plast Reconstr Aesthet Surg 2016;69(4):538-44.
- Lee HI, Ha SH, Yu SO, Park MJ, Chae SH, Lee GJ. Reverse sural artery island flap with skin extension along the pedicle. J Foot Ankle Surg 2016;55(3):470-5.
- Sugg KB, Schaub TA, Concannon MJ, Cederna PS, Brown DL. The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction. Plast Reconstr Surg Glob Open 2015;3(9):e519.
- Mohammadkhah N, Motamed S, Hosseini SN, et al. Complex technique of large sural flap: An alternative option for free flap in large defect of the traumatized foot. Acta Med Iran 2011;49(4):195-200.
- Muppireddy S, Srikanth R. Distally based reverse sural artery flap as an interpolation flap. Int J Res Orthop 2017;3(1):61-5.
- Ebrahiem AA, Manas RK, Vinagre G. Distally based sural artery peroneus flap (DBSPF) for foot and ankle reconstruction. Plast Reconstr Surg Glob Open 2017;5(4):e1276.
- Yilmaz M, Karatas O, Barutcu A.The distally based superficial sural artery island flap: Clinical experiences and modifications. Plast Reconstr Surg 1998;102(7):2358-67.
- Howard L, Keith EF, Alessio B, Steffen PB, Detlev E, Levin SL. The distally based sural flap for foot and ankle reconstruction. Tech Foot Ankle Surg 2007; 6(2):118-22.
- Park JK, Kim KY, Kim SH, Choi J, Yang JY. Versatility of delayed reverse sural flap for reconstruction of the distal lower extremity in high-risk patients. Arch Hand Microsurg 2017;22(4):280-7.
- Chang SM, Gu YD, Li JF. Comparison of different managements of large superficial veins in distally based fasciocutaneous flaps with a veno-neuro-adipofascial pedicle: An experimental study using a rabbit model. Microsurgery 2003;23(6):555-60.
- Wong CH, Tan BK. Intermittent short saphenous vein phlebotomy: an effective technique of relieving venouscongestion in the distally based sural artery flap. Ann Plast Surg 2007;58(3):303-7.
- Tan O, Atik B, Bekerecioglu M. Supercharged reverse-flow sural flap: A new modification increasing the reliability of the flap. Microsurgery 2005;25(1):36-43.
- Adel MT, Ahmed AH, Mohamed AN, Hazem ET. Distally based sural artery flap: Simple measures to ıncrease versatility and reduce complications. J Plast Reconstr Surg 2014;38(1):63-9.
- Herlin C, Sinna R, Hamoui M, Canovas F, Captier G, Chaput B. Distal lower extremity coverage by distally based sural flaps: Methods to increase their vascular reliability. Ann Chir Plast Esthet 2017;62(1):45-54.
- 15. Zhang FH, Chang SM, Lin SQ, et al. Modified distally based sural neuro-veno-fasciocutaneous flap: Anatomical study and clinical applications. Microsurgery 2005;25(7):543-50.
- Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994;93(5):1012-20.
- Mok WL, Por YC, Tan BK. Distally based sural artery adipofascial flap based on single sural nerve branch: Anatomy and clinical applications. Arch Plast Surg 2014;41(6):709-15.
- Chang SM, Li XH, Gu YD. Distally based perforator sural flaps for foot and ankle reconstruction. World J Orthop 2015;6(3):322-30.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 14, 2019 |
| Submission Date | December 22, 2018 |
| Published in Issue | Year 2019Volume: 58 Issue: 1 |
