Sural Fasciocutaneous Flap for Knee and Lower Leg Defects
Sural Fasciocutaneous Flap for Knee and Lower Leg Defects
The proximally based sural fasciocutaneous flap is an ideal alternative for reconstruction of soft tissue defects around the knee and on the proximal half of the lower leg. Its advantages include a thin sensate flap, good aesthetic outcomes, and reduced donor site morbidity. However, there have been limited reports regarding its clinical application. This study presents the use of the proximally based sural fasciocutaneous flap in 18 cases.
Materials and Methods. The series consisted of 18 cases (10 males) with an average age of 38.6 years and with a median follow-up time of 16 months. The defects were located around the knee in 3 cases and on the proximal half of the lower leg in 15 cases. The pivot point was between 1.5 cm and 2 cm distal to the popliteal skin crease and the fasciocutaneous pedicle was between 3 cm and 4 cm wide. The flap size ranged from 8 cm x 7 cm to 16 cm x 12 cm, and the pedicle length ranged from 12 cm to 18 cm. The anatomical structures consisted of the superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery with an islet of subcutaneous cellular tissue and skin.
Results. All 18 flaps survived. No arterial and venous crisis occurred postoperatively in any case. All donor sites had one-stage closure with split-thickness skin grafts and all the grafted skin survived without further surgical treatment. Functional deficits were not detected in any of these cases.
Conclusion. The proximally based sural fasciocutaneous island flap is reliable and suitable for reconstruction of soft tissue defects around the knee and on the proximal half of the lower leg with more versatility.
Soft-tissue defects around the knee and on the proximal lower leg are common due to trauma and postoncologic excision. There are various options available for reconstruction of such defects, usually including local muscle flap, fasciocutaneous flap, free flap, and cross-leg flap. Generally, a local muscle flap yields a bulky appearance and muscular function is damaged; a free flap requires excellent microsurgical technique, which limits its wide application in the authors' clinic; and a cross-leg flap inevitably brings about severe discomfort. While an island fasciocutaneous flap based on located perforator or fascial feeder vessels provides satisfactory coverage, as well as satisfactory cosmetic and functional outcomes, there have been limited clinical reports regarding proximally based sural fasciocutaneous island flaps for such reconstructions.
This study evaluates the clinical outcomes of using a proximally based sural fasciocutaneous island flap for reconstruction of traumatic soft-tissue defects around the knee and on the proximal lower leg.
Abstract and Introduction
Abstract
The proximally based sural fasciocutaneous flap is an ideal alternative for reconstruction of soft tissue defects around the knee and on the proximal half of the lower leg. Its advantages include a thin sensate flap, good aesthetic outcomes, and reduced donor site morbidity. However, there have been limited reports regarding its clinical application. This study presents the use of the proximally based sural fasciocutaneous flap in 18 cases.
Materials and Methods. The series consisted of 18 cases (10 males) with an average age of 38.6 years and with a median follow-up time of 16 months. The defects were located around the knee in 3 cases and on the proximal half of the lower leg in 15 cases. The pivot point was between 1.5 cm and 2 cm distal to the popliteal skin crease and the fasciocutaneous pedicle was between 3 cm and 4 cm wide. The flap size ranged from 8 cm x 7 cm to 16 cm x 12 cm, and the pedicle length ranged from 12 cm to 18 cm. The anatomical structures consisted of the superficial and deep fascia, the sural nerve, lesser saphenous vein, and superficial sural artery with an islet of subcutaneous cellular tissue and skin.
Results. All 18 flaps survived. No arterial and venous crisis occurred postoperatively in any case. All donor sites had one-stage closure with split-thickness skin grafts and all the grafted skin survived without further surgical treatment. Functional deficits were not detected in any of these cases.
Conclusion. The proximally based sural fasciocutaneous island flap is reliable and suitable for reconstruction of soft tissue defects around the knee and on the proximal half of the lower leg with more versatility.
Introduction
Soft-tissue defects around the knee and on the proximal lower leg are common due to trauma and postoncologic excision. There are various options available for reconstruction of such defects, usually including local muscle flap, fasciocutaneous flap, free flap, and cross-leg flap. Generally, a local muscle flap yields a bulky appearance and muscular function is damaged; a free flap requires excellent microsurgical technique, which limits its wide application in the authors' clinic; and a cross-leg flap inevitably brings about severe discomfort. While an island fasciocutaneous flap based on located perforator or fascial feeder vessels provides satisfactory coverage, as well as satisfactory cosmetic and functional outcomes, there have been limited clinical reports regarding proximally based sural fasciocutaneous island flaps for such reconstructions.
This study evaluates the clinical outcomes of using a proximally based sural fasciocutaneous island flap for reconstruction of traumatic soft-tissue defects around the knee and on the proximal lower leg.
Source...