Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2015; 6(3): 322-330
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.322
Distally based perforator sural flaps for foot and ankle reconstruction
Shi-Min Chang, Xiao-Hua Li, Yu-Dong Gu
Shi-Min Chang, Xiao-Hua Li, Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
Yu-Dong Gu, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Yu-Dong Gu, Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, China
Yu-Dong Gu, Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, China
Author contributions: Chang SM, Li XH and Gu YD contributed equally to this paper.
Supported by Natural Science Fundation of China (NSFC), No. 81271993; and by Shanghai Municipal Health and Family Planning Commission, No. 201440352.
Conflict-of-interest: The authors declare there is no conflict-of-interest about this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shi-Min Chang, MD, PhD, Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, China. shiminchang11@aliyun.com
Telephone: +86-21-65690520 Fax: +86-21-65690520
Received: January 9, 2015
Peer-review started: January 16, 2015
First decision: January 28, 2015
Revised: February 11, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: April 18, 2015
Processing time: 88 Days and 17.5 Hours
Abstract

Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

Keywords: Fasciocutaneous flap; Distally based flap; Foot and ankle; Perforator flap; Neurocutaneous flap; Sural flap; Propeller flap

Core tip: Distally based perforator sural flaps are perfused by a perforating artery issued from the deep peroneal or posterior tibial artery, and the longitudinal chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable rapid procedure for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. This paper presents the developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.