Clinical outcomes of reverse sural artery flap with the addition of lateral sural nerve and fasciocutaneous pedicle: Double sural nerve branches technique.

BACKGROUND

Soft tissue reconstruction of the distal lower extremity and foot is challenging for reconstructive surgeons, and reconstruction options are limited. Although reverse sural artery flap (RSAF) is often used in such cases, the incidence of complications requiring treatment is 14%. To reduce the incidence of complications, we performed the double sural nerve branches (DSNB) technique, a modified RSAF incorporating the medial and lateral sural nerves and a fasciocutaneous pedicle.

METHODS

This was a retrospective case series conducted at a single institution. In total, 22 patients who underwent reconstruction using the DSNB technique for soft tissue defects in the distal leg and foot, including traumatic and postoperative cases, between April 2013 and April 2023 were included.

RESULTS

The flap survived in all 22 patients, with no cases of partial or total flap loss. Marginal necrosis occurred in two patients (9.1%), both of whom also experienced venous congestion; however, neither condition required additional surgical intervention.

CONCLUSION

The complication rate associated with the DSNB technique was 9.1%, with a 100% flap survival rate. The DSNB technique may represent a useful modification of the RSAF; however, further studies are warranted to clarify its clinical utility.