OPTIMISING THE SUCCESSFUL OUTCOMES OF REVERSE SURAL ARTERY FLAP FOR LOWEREXTREMITY AND FOOT RECONSTRUCTION IN ELDERLY PATIENTS

Abstract

Soft tissue defects of the distal lower extremity and foot present major challenges in reconstruction. In elderly patients with co morbidities ,the reverse sural artery flap is a versatile tool in reconstruction of lower extremity and foot defect as they are poor candidates of free microsurgical flap. This study was conducted to assess the versatility of the flap to cover defects in varying sites of
the distal leg and foot and also its efficacy to serve as an alternative option for free microsurgical flap in the elderly patients (>60yrs).
MATERIALS AND METHODS All patients above 50 years of age who presented with lower extremity and foot defects underwent Reversal Sural Artery flap from January 2021 to January 2022 were included in this study. 19 patients were included in this study. The etiology of the defects were trauma, electrical burns injury and infection. The flaps were raised as pedicled, islanded and adipofascial flaps. Donor site was covered using split skin grafting in all cases. The patients were followed up for a minimum of 6 months.
RESULTS The mean age of the patients were 62.5 years. 15 male and 4 female patients were included. Size of the defects were minimum of 4x3 cm and maximum of 10x5 cm. 10 patients had diabetes mellitus and 5 patients had hypertension and 3 patients had both diabetes and hypertension and 1 patient had associated head injury. 4 patients had pre-operative flap delay followed by flap inset 7 days later. Pedicled RSA flap was done in 15 patients, adipofascial flap cover was done in 2 patients and islanded flap cover was done in 2 patients. Venous congestion present in most of the cases in early postoperative period. Flap settled uneventfully in 17 patients. 2 patients had distal flap necrosis for about 2 cm which was managed by debridement and advancement after which flaps settled well. All donor sites graft settled well.
CONCLUSION The reverse sural artery flap is a reliable alternative for free microsurgical flap cover for reconstruction of lower extremity and foot defects in elderly patients who are poor candidates for free microsurgical flap cover, with less operative time, easy learning curve, fewer complications and high success rates.