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19. Reverse Sural Artery Perforator Flap: Modified Pedical Dissection Technique

Kamran Khalid, Ammara Rabbani, Imran Shehzad, Muhammad Nasrullah, Muhammad Tariq Iqbal and Barira Bashir

ABSTRACT

Objective: To study the versatility of reverse sural artery perforator flap by modified pedical dissection technique, as are liable loco-regional flap to reconstruct distal limb and foot defects.

Study Design: Case series study

Place and Duration of Study: This study was conducted at the Jinnah Burn & Reconstructive Surgery Centre, Lahore from January 2010 to July 2017.

Materials and Methods: A total of 62 patients, 19 females (30%) and 43 males (70%) between 3 to 68 years of age with mean age of 19.4 years were included. Patient presenting to emergency department with 8 wounds on anterior distal 1/3 of tibia, 16 of ankle, 29 of heel and 9 wounds on dorsum of foot were included. Pre-operative hand held Doppler was done in all cases to mark the perforators. Per operative perforators were marked and a reliable perforator (> 1mm) size was selected and flap elevated. Adipo-fascial pedicle is elevated, with a width of 4cm to include the sural nerve and vein.

Results: Of the 62 cases operated in 50 patients (80%) the 2nd distal perforator at 7-10 cm and in 12 patients (20%) proximal perforator at 5 cm was found to be of good size. Adipo-fascial pedical width was kept at 4 cm. All flap survived completely. Only minor complications were seen in 8 (13%) flaps, distal 1cm tip necrosis in 3 flap and distal tip epidermolysis in 5 patients healed completely without intervention.

Conclusion: With the appropriate pre-operative planning and per-operative modifications sural flap is a reliable and versatile workhorse flap for distal lower limb and foot defect reconstruction.

Key Words: Reverse sural artery perforator flap, Modified pedical dissection technique, Dominant perforator, Pre-operative Doppler ultrasonography

Citation of articles: Khalid K, Rabbani A, Shehzad I, Nasrullah M, Iqbal MT, Bashir B. Reverse Sural Artery Perforator Flap: Modified Pedical Dissection Technique. Med Forum 2019;20(1):77-80.