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Dr. Brian M. Scholl, Dr. David
A. Volgas, University of Alabama at Birmingham
Soft tissue defects of the lower
third of the leg present a difficult treatment problem due
to lack of bulky, mobile tissue available for coverage. Historically
a free-flap is utilized for coverage, but it is a lengthy
and technically demanding procedure. A local fasciocutaneous
flap has recently been described. A reverse-flow sural fasciocutaneous
flap was performed in 47 patients treated between 1999 and
2001 for soft-tissue defects as a result of acute traumatic
wounds (19), wound dehiscence (26), diabetic ulcer (1) and
tumor excision (1). Patients were followed prospectively for
wound healing problems, further surgery, infections and outcomes.
Flap size ranged from 2x2 cm to 15x7 cm. The flap was healed
or healing in 44 patients (94%) and failed in 3 patients (6.4%).
56% of patients with a pre-existing osteomyletis had their
infections eradicated. Four patients required below-knee amputations
for persistent infections. Fifteen cases (32%) of partial
flap necrosis occurred, 13 healed without additional operative
intervention and 2 required skin grafting. Twelve patients
required 21 additional surgeries the majority of which were
related to ongoing deep infection. Patients with acute wounds
fared better versus chronic or dehisced wounds. The reverse-flow
sural fasciocutaneous flap can be successful in the treatment
of small to moderate sized soft-tissue injuries of the distal
third of the leg. The operative technique can be learned by
the orthopaedic traumatologist and does not require microsurgical
skills. Caution should be used when covering infected chronic
wounds.
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