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Eur J Plast Surg (2005) 28: 309–314DOI 10.1007/s00238-005-0769-4 The use of the reverse sural neurovenocutaneous flap in distal tibia,ankle and heel reconstruction Received: 9 September 2004 / Accepted: 14 March 2005 / Published online: 7 September 2005Ó Springer-Verlag 2005 Abstract The distal third of the tibia, ankle and heel The two nerves unite at the distal third of the leg and area is difficult to reconstruct. Microsurgery is an option but the time and the complexity of this type of procedure In three out of 20 fresh leg specimens studied, the is a disadvantage. For small to medium size defects, lateral sural nerve was not present. In order to avoid local flaps are often an easier alternative. Recent detailed confusion, the median sural nerve (the basis of the flaps anatomic studies have demonstrated the existence of the used) is called the sural nerve. This nerve courses in the perineural vascular plexus. In lower limb surgery, the midline of the leg and becomes superficial, penetrating sural flap is based on this principle and this flap is the deep fascia, at the midpoint of the leg. There it is becoming increasingly popular. Many articles have been accompanied by the lesser saphenous vein. Both the written with some contrasting opinions regarding the nerve and the lesser saphenous vein, along with a 3–5 cm anatomy, size of flap, location of the skin paddle, mode surrounding adipofascial pedicle, were used as the vas- of transfer and overall survival. The aim of this publi- cular basis of the flaps in this series of patients. The cation is to present a single surgeon’s experience in 17 pivot point was located 5 cm proximal to the lateral consecutive cases using the reverse sural flap for distal malleolus, or even lower if a loud perforator was de- tibia, ankle and heel reconstruction. The location of the tected by Doppler probe. This perforator is the anasto- defect, the flap dimensions, the results and complica- motic branch between the accompanying arteries of both tions are presented. Some conclusions are drawn and the nerve and the vein and the peroneal artery.
recommendations are made for maximum efficacy whenusing this flap, especially when used in older patients.
Keywords Sural flap Æ Reconstruction ÆSingle surgeon’s experience A total number of 17 patients were reconstructed withthe reverse sural neurovenocutaneous flap between 1997and 2003. Mean age was 62 years (range from 11 to91 years). Thirteen patients were male and four were female. Three patients suffered from type II diabetes. Nopatient, except one who was treated for a venostasis A study of 25 embalmed and ten fresh cadavers by Henk medial malleolus ulcer, had suffered from vessel disease Coert et al. [showed that the sciatic nerve divides into or obvious occlusive arteriopathy. In four cases the flap the common peroneal nerve and the posterior tibial included the superior third of the posterior leg within a nerves proximal to the fibular head. The medial sural few centimeters from the popliteal fossa (Figs. nerve originates from the posterior tibial nerve about All donor sites were closed directly except in three 6 cm proximal to the fibular head, while the lateral sural cases where a split-thickness skin graft was used for nerve originated from the common peroneal branch.
donor site closure. In one case the pedicle was exteri-orized; in 12 cases the flap was either tunneled or theintervening skin was opened and closed again over the pedicle; in four cases part of the flap’s pedicle was Veteran’s Hospital, 11521 Athens, Greece

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