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J Reconstr Microsurg 2017; 33(05): 343-351
DOI: 10.1055/s-0037-1598620
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps

Christian Herlin
1   Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
2   Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
,
Farid Bekara
1   Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
2   Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France
,
Nicolas Bertheuil
3   Department of Plastic, Reconstructive and Aesthetic Surgery, South University Hospital, Rennes, France
,
Raphael Carloni
4   Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle Hospital, Rouen, France
,
Sandy Dast
5   Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France
,
Raphael Sinna
5   Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France
,
Benoit Chaput
6   Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rangueil, Toulouse, France
› Author Affiliations
Further Information

Publication History

05 October 2016

26 December 2016

Publication Date:
24 February 2017 (online)

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Abstract

Background The use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps.

Methods We prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016.

Results No significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53, p = 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%, p = 0.01), as was coverage failure (23.7 vs. 2.6%, p = 0.035).

Conclusion There are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.

Keywords

sural flap - venous supercharging - reliability
 

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