Mehmet TAPAN, Yunus Emre ŞEKER, Taylan Cihan ZÖHRE, Ali Emre KORKUT, Özlenen ÖZKAN, Ömer ÖZKAN

Interpolation sural flap in acute trauma patients

Objectives: Distal lower leg wounds, regardless of cause, and acute trauma wounds, regardless of site, are difficult. Reconstruction of both situations are much more challenging. Interpolation sural flap is a good alternative for this type of reconstruction. Methods: Fourteen interpolation sural flap were harvested to reconstruct for distal leg region wounds due to acute trauma. Ten male and four female patients aged from 10 to 59 years old were included this study. Results: All flaps survived. No venous congestion and total flap necrosis was seen. There were 4 complications, and all of them were corrected with short interventions. After second stage, no complication was seen. Conclusions: Interpolation sural flap modification has many advantages including reliability, no venous congestion, immediate reconstruction without a surgical team. However, it is a two-staged reconstruction and its donor site scarring can be serious.

Keywords:

Acute trauma, distal lower leg defects, interpolation, sural flap, venous congestion,

PDF

___

1. Maffi TR, Knoetgen J 3rd, Turner NS, Moran SL. Enhanced survival using the distally based sural artery interpolation flap. Ann Plast Surg 2005;54:302-5.
2. Fachinelli A, Masquelet AC, Restepo J, Gilbert A. The vascularized sural nerve: anatomy and surgical approach. Int J Microsurg 1981;3:57.
3. Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Reconstr Surg 1983;17:191-6.
4. Masquelet AC, Beveridge J, Romana C, Gerber C. The lateral supramalleolar flap. Plast Reconstr Surg 1988;81:74-81.
5. 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.
6. Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994;93:1012-20.
7. Cavadas PC, Bonanad E. Reversed-flow sural island flap in the varicose leg. Plast Reconstr Surg 1996;98:901-2.
8. Buluç L, Tosun B, Sen C, Sarlak AY. A modified technique for transposition of the reverse sural artery flap. Plast Reconstr Surg 2006;117:2488-92.
9. Chang SM, Wang X, Huang YG, Zhu XZ, Tao YL, Zhang YQ. Distally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique. Ann Plast Surg 2014;72:340-5.
10. Ozkan O, Ozkan O, Cinpolat A, Bektas G. Reconstruction of distal lower extremity defects using the free peroneal artery perforator vessel based flap. Microsurgery 2014;34:629-32.
11. Li B, Chang SM, Du SC, Zhuang L, Hu SJ. Distally based sural adipofascial turnover flap for coverage of complicated wound in the foot and ankle region. Ann Plast Surg 2020;84:580-7.
12. Gir P, Cheng A, Oni G, Mojallal A, Saint-Cyr M. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg 2012;28:595-601.
13. Saaiq M, Zimri FUK. Reverse flow superficial sural artery fasciocutaneous flap: a comparison of outcome between interpolated flap design versus islanded flap design. World J Plast Surg 2019;8:316-23.
14. Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg 2007;119:138e-48e.
15. Wong CH, Tan BK. Maximizing the reliability and safety of the distally based sural artery flap. J Reconstr Microsurg 2008;24:589-94.
16. Cherubino M, Stocco C, Ronga M, Tamborini F, Maggiulli F, Di Giovanna D, et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery 2020;40:452-9.
17. Lin TS, Quing R. Long-term results of a one-stage secondary debulking procedure after flap reconstruction of the foot. Plast Reconstr Surg 2016;138:923-30.
18. Maffi TR, Knoetgen J 3rd, Turner NS, Moran SL. Enhanced survival using the distally based sural artery interpolation flap. Ann Plast Surg 2005;54:302-5
19. Liang W, Tan BK. Use of the cross-leg distally based sural artery flap for the reconstruction of complex lower extremity defects. Arch Plast Surg 2019;46:255-61.
20. Tapan M, Özkan Ö, Özkan Ö. Versatility of the peroneal perforator propeller sural flap for various types of injuries in the ankle and foot regions. Ann Plast Surg 2021;87:e121-8.
21. Yu JW, Rifkin WJ, Lee ZH, Borab Z, Alfonso AR, Thanik VD, et al. Does laterality of lower extremity donor site affect outcomes in microvascular soft tissue lower extremity reconstruction? J Reconstr Microsurg 2020;36:289-93.
22. Gravvanis A, Kateros K, Apostolou K, Karakitsos D, Tsoutsos D. Changes in donor site selection in lower limb free flap reconstructions by integrating duplex ultrasonography in the preoperative design. Acta Chir Plast 2013;55:3-9.