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.