The Distally Based Adipofascial Sural Artery Flap: Faster, Safer, and Easier? A Long-Term Comparison of the Fasciocutaneous and Adipofascial Method in a Multimorbid Patient Population

Background: Complex wounds of the distal third of the leg are challenging to treat. Despite free tissue transfer, local pedicled flaps such as the distally pedicled sural artery flap remain a valuable option. Methods: The authors conducted a retrospective comparison of the classical harvesting technique of the sural artery flap with a simplified method without a skin island. Results: We report on 148 patients who were treated with 104 adipofascial flaps and 44 fasciocutaneus flaps from 1997 to 2010. The adipofascial group showed a shorter operative time and a better aesthetic outcome. Complications did not differ in this multimorbid patient group. Conclusions: With a simple modification, the distally based sural artery flap is easier and faster to perform. The study shows that the adipofascial flap is as safe as the classic version, with the advantage of an improved donor-site appearance. Therefore, the described technique is a valuable tool in cases where free tissue transfer is not suitable. (Plast. Reconstr. Surg. 130: 360, 2012.)