J Reconstr Microsurg 2021; 37(07): 580-588
DOI: 10.1055/s-0041-1723817
Original Article

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Ling-Li Zhou
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Jian-Wei Wei
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Ping Peng
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Li-Hong Liu
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Chao-Dong Yin
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Zhao-Biao Luo
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Shi-Bin Tao
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
,
Zhong-Gen Dong
1  Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
› Author Affiliations
Funding This work is supported by the National Natural Science Foundation of China (no.: 81672188) and Health and Family Planning Commission of Hunan Province (no.: B20180313).

Abstract

Background This study is to describe the distribution of natural true anastomoses associated with the distally based perforator-plus sural neurocutaneous flap (sural flap), summarize our experience in the flap with high pivot point, and compare the outcomes between the flaps with high and low pivot points.

Methods Five amputated lower limbs were perfused, and the integuments were radiographed. We retrospectively analyzed 378 flaps, which were divided into two groups: pivot points located ≤8.0 cm (low pivot point group) and >8.0 cm (high pivot point group) proximal to the tip of the lateral malleolus. Partial necrosis rates were compared between two groups.

Results The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. True anastomoses existed among peroneal perforators and between these perforators and the arterial chain. There were 93 flaps with high pivot point and 285 flaps with low pivot point. Partial necrosis rates were 16 and 9.1% in the high and low pivot point group (p = 0.059), respectively.

Conclusion True anastomosis connections among peroneal perforators and the whole arterial chain around sural nerve enable the sural flap to survive with a greater length. The sural flap with high pivot point is a good option for reconstructing soft-tissue defects in the middle and distal leg, ankle, and foot, particularly when the lowest peroneal perforator presents damage, greater distance to the defects, discontinuity with the donor site, or anatomical variation.

Note

This article has been presented in the session FP 16, Lower Limb of the 10th Congress of World Society for Reconstructive Microsurgery (WSRM 2019), Bologna, Italy, June 12–15, 2019.




Publication History

Received: 16 July 2020

Accepted: 21 December 2020

Publication Date:
16 February 2021 (online)

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