Versatility of The Sural Flap for Reconstruction of Leg Defects: Experience of the LIC. Adolfo López Mateos Medical Center in Patients with Limited Access to Microsurgery
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Abstract
The sural flap is a reliable reconstructive option for patients with defects ranging from the knee and popliteal fossa to the distal third of the leg, including the ankle, particularly in settings where microsurgery is unavailable or inaccessible due to patient-related factors. Its consistent vascular supply, technical simplicity, and versatility make it a key tool in reconstructive surgery. This study aims to evaluate the versatility, effectiveness, and complications of the sural flap in the reconstruction of leg defects in patients without access to microsurgery, through a retrospective analysis conducted at the Lic. Adolfo López Mateos Medical Center. Among 14 patients, 13 (92.8%) achieved successful flap integration. One patient (7.1%) developed vascular pedicle thrombosis within 24 hours, requiring flap takedown and surgical reintervention. Minor complications included seroma formation (<2 ml) in 3 cases, wound dehiscence less than 1 cm in 2 cases, and greater than 1 cm in one case, which was resolved with an outpatient skin graft. Transient venous congestion occurred in 4 reverse flaps. All patients recovered functional ambulation, and 12 (85.7%) reported satisfaction with both aesthetic and functional outcomes. Thirteen patients were discharged within 48 hours postoperatively. The pedicled sural flap is a dependable option for lower limb reconstruction, offering high success rates, low morbidity, and favorable patient acceptance in terms of function and aesthetics. Its use should be especially considered when effective soft tissue coverage is required without the need for microsurgical techniques.
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References
I. Sosa Murillo Roberto Alejandro, Murillo, (2025). The Sural Flap: Anatomical Basis, Technical Refinements, And Clinical Applications in Lower Extremity Reconstruction. International Journal Of Medical Science And Clinical Research Studies, 05(06). https://doi.org/10.47191/ijmscrs/v5-i06-05
II. Tripathee, S., Basnet, S. J., Lamichhane, A., & Hariani, L. (2022). How Safe Is Reverse Sural Flap?: A Systematic Review. Eplasty, 22, e18.
III. Sadeghi, P., & Pandey, S. (2023). The Versatility of the Pedicled Medial Sural Artery Perforator Flap: From Simple to Its Chimeric Pattern and Clinical Experience with 37 Cases. Plastic and reconstructive surgery, 151(2), 345e. https://doi.org/10.1097/PRS.0000000000009870
IV. Deek, N. F. A., Hsiao, J. C., Do, N. T., Kao, H. K., Hsu, C. C., Lin, C. H., & Lin, C. H. (2020). The Medial Sural Artery Perforator Flap: Lessons Learned from 200 Consecutive Cases. Plastic and reconstructive surgery, 146(5), 630e–641e. https://doi.org/10.1097/PRS.0000000000007282
V. Romero EJF, Del Villar TA, Cobos BMG, et al. Colgajo sural reverso para reconstrucción en zona 5 y 6 de Hollenbeck. Informe de casos. Cir Plast. 2018;28 (3):120-125. Doi:10.35366/CP183E.
VI. Lin, C. H., Hsieh, Y. H., & Lin, C. H. (2021). The Medial Sural Artery Perforator Flap in Lower Extremity Reconstruction. Clinics in plastic surgery, 48(2), 249–257. https://doi.org/10.1016/j.cps.2021.01.003
VII. Cho, Á. B., Ferreira, C. H. V., de Mendonça, P. G. M., Sorrenti, L., & Kiyohara, L. Y. (2023). HARVESTING SURAL FLAP WITH COVERED PEDICLE. Acta ortopedica brasileira, 31(spe1), e257850. https://doi.org/10.1590/1413-785220233101e257850
VIII. Schmidt, K., Jakubietz, M., Meffert, R., Gilbert, F., Jordan, M., & Jakubietz, R. (2020). The reverse sural artery flap- How do modifications boost its reliability? A systematic analysis of the literature. JPRAS open, 26, 1–7. https://doi.org/10.1016/j.jpra.2020.07.004
IX. Clivatti, G. M., Nascimento, B. B. D., Ribeiro, R. D. A., Milcheski, D. A., Ayres, A. M., & Gemperli, R. (2022). REVERSE SURAL FLAP FOR LOWER LIMB RECONSTRUCTION. Acta ortopedica brasileira, 30(4), e248774.
https://doi.org/10.1590/1413-785220223004e248774
X. Persaud, S., Chesser, A., Pereira, R., & Ross, A. (2017). Sural Flap Use for the Treatment of Wounds With Underlying Osteomyelitis: Graft Size a Predictor in Outcome, a Systematic Review. Foot & ankle specialist, 10(6), 560–566. https://doi.org/10.1177/1938640017729496
XI. Daar, D. A., Abdou, S. A., Cohen, J. M., Wilson, S. C., & Levine, J. P. (2019). Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery, 143(2), 393e–403e. https://doi.org/10.1097/PRS.0000000000005204
XII. Finkemeier, C. G., & Neiman, R. (2016). Reverse Sural Artery Pedicle Flap. Journal of orthopaedic trauma, 30 Suppl 2, S41–S42. https://doi.org/10.1097/BOT.0000000000000613
XIII. Daar, D. A., Abdou, S. A., David, J. A., Kirby, D. J., Wilson, S. C., & Saadeh, P. B. (2020). Revisiting the Reverse Sural Artery Flap in Distal Lower Extremity Reconstruction: A Systematic Review and Risk Analysis. Annals of plastic surgery, 84(4), 463–470. https://doi.org/10.1097/SAP.0000000000002041
XIV. Peng, P., Dong, Z., Liu, L., Wei, J., Luo, Z., & Cao, S. (2021). Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery, 35(6), 750–755. https://doi.org/10.7507/1002-1892.202101105
XV. Peng, P., Dong, Z., Wei, J., Liu, L., Luo, Z., Cao, S., & Zheng, L. (2022). Revisit of flap factors relating to partial necrosis of distally based sural flaps: an analysis of 435 cases in a single center. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 48(3), 2359–2368. https://doi.org/10.1007/s00068-021-01737-6
XVI. Dong, Z., Wei, J., Liu, L., Luo, S., He, M., Zhou, Z., Deng, X., & Yang, Y. (2010). Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences, 35(7), 754–759. https://doi.org/10.3969/j.issn.1672-7347.2010.07.018
XVII. Canales, A. V., & Martínez, J. C. (2022). Resultados del uso de colgajo sural reverso para cobertura de extremidad inferior. Revista Española de Cirugía Plástica, 35(2), 109-116. https://dx.doi.org/10.4321/s0376-7892202000030008
XVIII. Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, D. (2018). An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 21(1), 27–32. https://doi.org/10.1016/j.jval.2017.07.007
XIX. Fife, C. E., & Carter, M. J. (2012). Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry. Wounds : a compendium of clinical research and practice, 24(1), 10–17.
XX. Universal Medical Travel. (2023). Plastic Surgery Cost in Mexico. https://universalmedicaltravel.com/es/plastic-surgery-cost-in-mexico/