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Reverse Sural Artery Flap: Anatomic Study of Peroneal Perforators and Modifications for Coverage of Medial and Distal Foot Defects
Xiao Zhu, Guilherme Barreiro
University of Pittsburgh Medical Center
2021-01-17
Presenter: Xiao Zhu
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: The Reverse Sural Artery Flap (RSAF) is a powerful option for coverage of ankle, heel, and foot defects. We describe peroneal perforator distribution in cadaveric legs, and our clinical experience with four novel modifications (perforator skeletonization, Achilles tendon release, tunneling under the Achilles tendon, proximal peroneal artery ligation) to allow greater reach for the RSAF to cover medial and distal forefoot defects.
Methods: 38 cadaveric legs were dissected to identify peroneal perforators. Perforator distribution and associated characteristics were obtained. 12 patients between 5-73 years-old underwent the RSAF and the described modifications for a variety of defects. Outcomes and complications were reported.
Results: There were on average 3.63 perforators per cadaveric leg. The terminal perforator was found a mean distance of 10.96 cm above the lateral malleolus. These results were comparable to those found in our clinical series, where the terminal perforator in adults was identified on average 9.3 cm from the lateral malleolus. However, due to improved perforator/pedicle mobility provided by the described modifications, the pivot point was able to be lowered to a mean distance of 6.7 cm. Of the 12 patients, two had <10% distal tip necrosis and one had 50% superficial epidermolysis, all of which healed with local wound care.
Conclusion: This study highlights the effectiveness of four novel modifications to the RSAF. Furthermore, anatomic studies demonstrate that the terminal peroneal perforator may lie higher than the recommended 5 cm pivot point above the lateral malleolus, making these modifications crucial in some cases.
