Reconstruction full-thickness defect of calcaneus post trauma using sural fascio-cutaneous flap: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20250145Keywords:
Full-thickness defect, Trauma, Sural flap, Case reportAbstract
Traffic accidents often cause degloving injuries to the extremities that can cause an avulsion of the skin. Injuries of the feet and lower legs require special management, specifically the calcaneus region, which is an anatomical challenge for reconstructive surgery. The sural flap is often used for calcaneus defect reconstruction. This method provides more volume compared to skin graft methods. We report the case of a 33-year-old woman who was injured in a motorcycle accident. The patient had a wound on the calcaneus about 8 cm×3 cm long, just below the medial malleolus. The wound is circular, leaving intact tissue as a pedicle with a plantar pedis measuring 3 cm×2×cm×1 cm. The patient underwent debridement with a sural flap. Follow-up post-surgery, the flap was viable, but other procedures (casting, in setting flap, and refinement flap) are still needed to achieve better outcomes and physiotherapy to restore function. Degloving injuries generally cause devascularization. In cases like this, debridement is used as the initial therapy to preserve the surrounding soft tissue and skin. The second treatment is to prevent contractures. Most surgeons recommend a skin graft in the first stage. We performed a flap that has a rapid reconstruction process and can prevent the risk of skin necrosis as a weight-bearing area. Due to the existence of a long, retractable vascular pedicle, the sural flap is a helpful treatment in the reconstruction of skin defects in the distal area of the lower extremity. Reconstruction using fasciocutaneous flap procedure, for the patient's lower extremity defect (calcaneal defect) was successful. In trauma cases that cause damage full full-thickness skin and soft tissue, it is advisable to perform a flap as one of the reconstructive surgery procedures to restore the best function and shape of the involved lower extremity.
Metrics
References
Akduman B, Ustun G, Gursoy K, Kocer U. Use of avulsed skin flap as donor site for reconstruction of total forearm skin avulsion injuries. Turkish J Plast Surg. 2019;27(4):211. DOI: https://doi.org/10.4103/tjps.tjps_97_18
Lim H, Han DH, Lee IJ, Park MC. A simple strategy in avulsion flap injury: Prediction of flap viability using Wood’s lamp illumination and resurfacing with a full-thickness skin graft. Arch Plast Surg. 2014;41(2):126–32. DOI: https://doi.org/10.5999/aps.2014.41.2.126
Wang C, Xiong Z, Xu J, Zhang L, Huang H, Li G. The distally based lateral sural neuro-lesser saphenous veno-fasciocutaneous flap: anatomical basis and clinical applications. J Orthop Traumatol. 2014;15(3):215–23. DOI: https://doi.org/10.1007/s10195-012-0202-2
Hamdi MF, Kalti O, Khelifi A. Experience with the Distally Based Sural Flap: A Review of 25 Cases. J Foot Ankle Surg. 2012;51(5):627–31. DOI: https://doi.org/10.1053/j.jfas.2012.05.029
Roberts HJ, Desilva GL. Can Sural Fasciocutaneous Flaps Be Effective in Patients Older Than 65? Clin Orthop Relat Res. 2020;478(4):734–8. DOI: https://doi.org/10.1097/CORR.0000000000000963
6. Severo AL, Coppi EFM, Cavalheiro HL, Dal Bosco AL, Filho DB, Lemos MB. Lower limb reconstruction. Fasciocutaneous sural flap. Rev Bras Ortop. 2019;54(2):128–33. DOI: https://doi.org/10.1016/j.rbo.2017.12.016
Hosseinzadeh AZ. Full-Thickness Skin Avulsion of Right Leg Following Car Accident Trauma.pdf. Pakistan J Biol Sci. 2008;11(10):1401–4. DOI: https://doi.org/10.3923/pjbs.2008.1401.1404
Schannen AP, Truchan L, Goshima K, Bentley R, De Silva GL. Sural versus perforator flaps for distal medial leg wounds. Orthopedics. 2015;38(12):1059–64. DOI: https://doi.org/10.3928/01477447-20151120-01
Vaienti L, Di Matteo A, Gazzola R, Randelli P, Lonigro J. Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware. J Orthop Traumatol. 2012;13(1):35–9. DOI: https://doi.org/10.1007/s10195-011-0175-6
Masquelet AC, Romana MC, Wolf G. Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial Nerves. Vol. 89, Plastic and Reconstructive Surgery. 1992;89:1115–21. DOI: https://doi.org/10.1097/00006534-199206000-00018
Le Fourn B, Caye N, Pannier M. Distally based sural fasciomuscular flap: anatomic study and application for filling leg or foot defects. Plast Reconstr Surg. 2001;107:67–72. DOI: https://doi.org/10.1097/00006534-200101000-00011
Dhamangaonkar AC, Patankar HS. Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: experience of 109 clinical cases. J Orthop Traumatol. 2014;15(3):225–9. DOI: https://doi.org/10.1007/s10195-014-0304-0
Turan K, Tahta M, Bulut T, Akgün U, Sener M. Soft tissue reconstruction of foot and ankle defects with reverse sural fasciocutaneous flaps. Rev Bras Ortop. 2018;53(3):319–22. DOI: https://doi.org/10.1016/j.rboe.2017.05.002
De Blacam C, Colakoglu S, Ogunleye AA, Nguyen JT, Ibrahim AMS, Lin SJ, et al. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: A systematic review and pooled analysis. J Plast Reconstr Aesthetic Surg. 2014;67(5):607–16. DOI: https://doi.org/10.1016/j.bjps.2014.01.044
Wei JW, Dong ZG, Ni JD, Liu LH, Luo SH, Luo ZB, et al. Influence of flap factors on partial necrosis of reverse sural artery flap: A study of 179 consecutive flaps. J Trauma Acute Care Surg. 2012;72(3):744–50. DOI: https://doi.org/10.1097/TA.0b013e31822a2f2b
Yang D, Morris SF. Reversed sural island flap supplied by the lower septocutaneous perforator of the peroneal artery. Ann Plast Surg. 2002;49(4):375–8. DOI: https://doi.org/10.1097/00000637-200210000-00007
Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Fukui Y, Miyasaka T, et al. Accompanying Arteries of the Lesser Saphenous Vein and Sural Nerve: Anatomic Study and Its Clinical Applications. Plast Reconstr Surg. 1999;103(1):104–20. DOI: https://doi.org/10.1097/00006534-199901000-00018
Ciofu RN, Zamfirescu DG, Popescu SA, Lascar I. Reverse sural flap for ankle and heel soft tissues reconstruction. J Med Life. 2017;10(1):94–8.
Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg. 2007;119(6):138–48. DOI: https://doi.org/10.1097/01.prs.0000259203.79909.7e
Parrett BM, Pribaz JJ, Matros E, Przylecki W, Sampson CE, Orgill DP. Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction. Plast Reconstr Surg. 2009;123(5):1499–504. DOI: https://doi.org/10.1097/PRS.0b013e3181a07723