Dados do Trabalho

Título / Title

REDUCTION OF MORBIDITY WITH A REVERSE-FLOW SURAL FLAP: A TWO-STAGE TECHNIQUE

Introdução / Introdution

The reverse sural flap has often been used for cutaneous coverage of the distal region of the leg and ankle.
When the flap is performed in 2 stages, the vascular pedicle is exteriorized and later resected.

Objetivo / Purpose

Our goal was to assess the reverse sural flap performed in 2 stages regarding its viability and lower morbidity along
the flap-donor area.

Material e Método / Material and Methods

Eleven patients with cutaneous coverage loss found in the area between the distal third of the leg and ankle underwent cutaneous coverage surgery with a reverse-flow sural flap with an exteriorized pedicle, without violation of the skin between the base of the flap pedicle to the margin of the wound. After a minimum period of 15 days with flap autonomy, the pedicle was resected. The flap dimensions, its viability before and after the pedicle ligature, and the distance from the intact skin between the flap base and the margin of the wound were evaluated. Any losses were measured as a percentage of the total flap size.

Resultados / Results

The respective length and width of the flap were a mean average of 7.45 cm × 4.18 cm.
All the flaps survived. Partial loss of the flap occurred in 3 patients, ranging from 20% to 30%. The mean
average distance of the intact skin between the pedicle base and the margin of the wound was 5.59 (range
4 to 8) cm.

Discussão / Discussion

The reverse sural flap, initially described by Masquelet et al in 1992, is a good option for coverage of the distal third of the leg and the ankle owing to its proximity to the injured area and the good results achieved in flap survival, which has been corroborated in numerous reported studies. However, we have observed, with variable frequency, the occurrence of partial or total loss of this flap, especially due to congestion. Such complications can be aggravated by tunneling of the pedicle, which can result in its compression.
Another form of flap transposition, which prevents the formation of a subcutaneous tunnel, is a skin incision between the pedicle base and the flap margin. This associates the pedicle coverage with the partial skin graft or leaves a skin extension along the pedicle. In addition to the existing possibility of pedicle compression due to graft tension at the time of suturing, the aesthetics will also compromised, represented by local bulking.