The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction
Research article published in Plastic and reconstructive surgery. Global open (2015)
Abstract
BACKGROUND: Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon. The reverse superficial sural artery flap (RSSAF) is a popular option for many of these difficult wounds. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. To overcome this, we have modified our operative technique, which has produced a more reliable flap. METHODS: All patients reconstructed with an RSSAF between May 2002 and September 2013 were retrospectively reviewed. In response to a high rate of venous congestion in an early group of patients, we adopted a uniform change in operative technique for a late group of patients. A key modification was an increase in pedicle width to at least 4 cm. Outcomes of interest included postoperative complications and limb salvage rate. RESULTS: Twenty-seven patients were reconstructed with an RSSAF (n = 12 for early group, n = 15 for late group). Salvage rate in the early group was 50% compared with 93% in the late group (P = 0.02). Postoperative complications (75% vs. 67%, P = 0.70) were similar between groups. Venous congestion that required leech therapy was 42% in the early group (n = 5) and 0% in the late group (P = 0.01). CONCLUSIONS: Venous congestion greatly impairs the survival of the RSSAF. A pedicle width of at least 4 cm is recommended to maintain venous drainage and preserve flap viability.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon.
Why This Matters for Hirudotherapy
This retrospective review of 27 patients reconstructed with a reverse superficial sural artery flap compared an early group (pedicle width not standardized) with a late group (pedicle width ≥4 cm), finding improved limb salvage (93% vs. 50%) and elimination of venous congestion requiring leech therapy (0% vs. 42%) in the late group. The article is relevant to ASH because leech therapy was used as a clinical intervention for venous congestion in the early cohort, illustrating a real reconstructive surgery application of hirudotherapy. However, the study's primary focus is surgical technique modification; leech therapy is reported only as a complication metric, not evaluated for efficacy or outcomes. No leech secretome biochemistry is addressed.
Citation
The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction
Sugg KB et al. · Plastic and reconstructive surgery. Global open, 2015
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