From the Guidelines
The reverse sural artery flap pedicle is a fasciocutaneous flap that utilizes the sural nerve and accompanying vascular pedicle, typically based on the median superficial sural artery, to provide blood supply to the flap 1.
Key Characteristics
- The pedicle is usually dissected to a length of 5-7 cm, allowing for coverage of defects in the lower leg, ankle, and foot.
- The flap is often used for reconstructive surgery in patients with lower extremity peripheral artery disease, as discussed in the 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1.
- Post-operative management may include administration of low-molecular-weight heparin, such as enoxaparin 40mg subcutaneously daily, for a duration of 7-10 days to reduce the risk of venous thromboembolism.
Clinical Considerations
- The choice of flap and pedicle length may depend on the anatomic location and characteristics of the defect, as well as the patient's overall health status and comorbidities 1.
- The use of endovascular revascularization may be considered in patients with severe limb ischemia, as discussed in the 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1.
- The angiosome concept may be applied in the treatment of nonhealing wounds due to chronic limb-threatening ischemia, where direct blood flow to the affected limb is established 1.
From the Research
Reverse Sural Artery Flap Pedicle
The reverse sural artery flap pedicle is a fasciocutaneous flap that relies on the reverse flow of the sural artery, which is a branch of the popliteal artery 2, 3, 4, 5, 6. The pedicle of the flap typically includes:
- The superficial and deep fascia
- The sural nerve
- The short saphenous vein
- The superficial sural artery
- An islet of subcutaneous cellular tissue and skin
Characteristics of the Pedicle
The characteristics of the pedicle can vary, but it is typically:
- 3-4 cm in width 2
- Located near the popliteal skin crease, with the most proximal border of the flap being only 1.5 cm away from the crease 2
- The pivot point is usually 5-7 cm above the tip of the lateral malleolus 2
Blood Supply
The blood supply to the flap comes from the lower perforators of the peroneal artery, which provides reverse flow to the sural artery 2. This allows the flap to be used for reconstruction of soft tissue defects in the distal lower limb, including the foot and ankle.
Advantages and Uses
The reverse sural artery flap pedicle has several advantages, including:
- Easy dissection and preservation of important vascular structures in the limb 4
- Complete coverage of soft tissue defects in one operation without the need for microsurgical anastomosis 4
- Can be used to treat patients with large and complex soft tissue defects in the lower limb, including those with associated morbidity such as diabetes and vascular disease 3, 6