Distally-Based Sural Island Flap for Soft Tissue Coverage of Ankle and Heel Defects

Objective: To determine the outcome of heel and ankle reconstruction with distally-based sural island flap. Study Design: Case series. Place and Duration of Study: The study was carried out in Plastic Surgery Department, Chittagong Medical College Hospital, from January 2007 to April 2009. Methodology: Twenty two subjects with soft tissue defect of heel and ankle requiring coverage were included in the study. The flap was first outlined on the posterior aspect of leg at the junction of upper and middle-third. Having incision made over the designed flap and along the line of the fascial pedicle, the vessels and the nerve were ligated at the proximal margin and severed. The skin island was elevated with the deep fascia. The sub-cutaneous fascial pedicle was then raised, with a width of 2.5 cm to include the sural nerve and vessels. The recipient defect was covered after tunneling the island flap. The donor site was closed directly when the wound was less wide and with a split skin graft when the wound was large. Results were analyzed in terms of graft acceptance and complications determined as percentage frequencies. Results: Of the 22 patients, 15 had uneventful recovery with almost complete take of flaps. Although 5 patients showed marginal necrosis initially, they later on healed by secondary intention without requiring any secondary graft coverage. The rest two had a marked loss of flap in the peripheral part and required secondary graft coverage. Immediate venous congestion was commonly encountered which disappeared within a few days. There were no delayed complaints regarding sensation of the flaps. Conclusion: Distally-based sural island flap can be performed as a one-step procedure without sacrifice of any major artery. It is reliable, safe and should be the choice for reconstruction of ankle and heel defects.