Use of reverse flow sural flap in leg skin defects Acívar Hospital 2025.

Abstract

Introduction: Skin defects caused by high-energy trauma to the lower extremity present a reconstructive challenge. The reverse flow sural flap (CSFR) is an established, easy-to-execute, low-morbidity orthoplastic technique at the donor site, ideal for tissue coverage of the distal third of the leg and foot. Objective: To evaluate the functional outcomes and analyze the medium-term complications of the sural reverse flow flap (SRHRF) in patients with severe lower limb trauma.

Materials and methods: A retrospective observational study was conducted on two young male patients (15 and 17 years old) with severe lower limb trauma (Gustilo and Anderson type IIIB) and skin coverage loss. Both patients required multiple surgical cleanings and orthoplastic procedures. One patient was treated with CSFR, and the other with a combination of double flap (including CSFR) for coverage. Postoperative function was assessed using the LEFS (Lower Extremity Functional Scale) and AOFAS (American Orthopaedic Foot and Ankle Society Score) scales at 3 and 4 months, respectively.

Results: The cause of injuries was a traffic accident in all cases. Vascular integration of the flap was 100%. The most common complication was venous congestion (100%) within the first 24 hours, which was successfully managed by releasing flap tension through suture removal. There were no cases of total or partial necrosis, pedicle thrombosis, or infection. Medium-term functional outcomes were favorable in both patients: LEFS scores of 62/80 and 66/80 (mild disability) and AOFAS scores of 80/100 and 85/100, respectively.

Conclusion: The reverse flow sural flap is a safe and effective option for covering skin defects in the distal third of the leg and foot after severe trauma. Active monitoring and reducing tension during flap closure are crucial to prevent venous congestion and ensure vascular integration, resulting in positive functional outcomes in the medium term.