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.
Resumen
Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon.
Por qué esto importa para la hirudoterapia
Esta revisión retrospectiva de 27 pacientes reconstruidos con un colgajo reverso de la arteria sural superficial comparó un grupo temprano (ancho del pedículo no estandarizado) con un grupo tardío (ancho del pedículo ≥4 cm), encontrando una mejoría en la salvación de la extremidad (93% vs. 50%) y la eliminación de la congestión venosa que requirió terapia con sanguijuelas (0% vs. 42%) en el grupo tardío. El artículo es relevante para ASH porque la terapia con sanguijuelas se utilizó como intervención clínica para la congestión venosa en la cohorte temprana, lo que ilustra una aplicación real de la hirudoterapia en cirugía reconstructiva. Sin embargo, el enfoque principal del estudio es la modificación de la técnica quirúrgica; la terapia con sanguijuelas se reporta solo como una métrica de complicación, y no se evalúa su eficacia ni sus resultados. No se aborda la bioquímica del secretoma de la sanguijuela.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026