Background The distally based sural artery flap is a reliable, local reconstructive option
for small soft tissue defects of the distal third of the leg. The purpose of this
study is to describe an adipofascial flap based on a single sural nerve branch without
sacrificing the entire sural nerve, thereby preserving sensibility of the lateral
foot.
Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four
patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction
using the adipofascial flap, which incorporated the distal peroneal perforator, short
saphenous vein, and a single branch of the sural nerve.
Results From the anatomical study, the distal peroneal perforator was situated at an average
of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and
lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm
(14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They
merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve
at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This
merging point determined the pivot point of the flap. In the clinical cases, all patients
reported near complete recovery of sensation over the lateral foot six months after
surgery. All donor sites healed well with a full range of motion over the foot and
ankle.
Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss,
a good range of motion, an aesthetically acceptable outcome and can be performed by
a single surgeon in under 2 hours.
Keywords
Surgical flaps - Perforator flap - Sural nerve - Hypesthesia - Soft tissue injuries
