Non-Islanded Distally Based Sural Artery Flap : A Reliable Solution for an Unreliable Flap

To assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure (partial and major flap necrosis), number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel. Cohort study. Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014. Distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05. The mean age of patients was 38.4 ±16.2 years in G1 and 35.1 ±18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 ±1 and 2 ±1 in G2 (p < 0.001). The mean hospital stay in G1 was 43.1 ±3.6 days while 27.9 ±2.1 days in G2 (p < 0.001). There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps (G1) and in 9 out of 41 non-islanded flaps (G2) (p=0.0203). Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps (p=0.024). Distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap.