Introduction: To present the experience of an Orthopaedic Surgeon, certified consultant with no microsurgery or plastic surgery qualification working at a level one trauma center in managing soft tissue coverage of lower one third of tibia, ankle and the heel.
Patients and Methods: Four patients, three males and one female, with soft tissue defect of lower one third tibia, ankle and the Heel requiring soft tissue cover were treated from August 2008 to August 2010. The Distally based suralis fasciocutaneous flap was harvested from the posterior aspect of the calf. The pedicle pivot is at least 5 cm proximal to the lateral mallelous to allow anastomosis with the peroneal artery via the constant peroneal perforators. Skin incision was started along the mid line of the calf posteriorly stoping 5 cm at least proximal to lateral malleolus which the fascial pedicle would be taken. The subdermal layer dissected to expose the sural nerve, accompanying superficial sural vessels and short saphenous vein.1 The subcutaneous facial pedicle elevated, with a width of 3cm to include the nerve and these vessels will pivot. At the proximal margin of the flap, the nerve and the vessels were ligated and severed.2 The skin island was elevated with the deep fascia. The donor site defect was covered with a split thickness skin graft from epsilateral thigh.
Results: Well tolerated procedure by all patients, no plastic surgery or reoperation was need for any of the four cases, Survival of all flaps, maintenance of orthopaedic fixation, one flap showed some venous engorgement which subsided gradually in a few days. Complete take of all split skin graft over donor site bed.
Conclusion: Distally based Sural artery flap is a good choice for reconstruction of soft tissue defects of lower 1/3 tibia, ankle and foot. The procedure is easy and should be done by an Orthopaedic surgeon when needed.
Soft tissue defects distally based sural artery flap, Lower 1/3 tibia, ankle & foot.