Versatile distally based neurocutaneous saphenous flap in the era of microsurgery

Abstract

Background

The reconstruction of soft tissue defects in the distal third of the leg and ankle joint remains a challenge for reconstructive surgeons. Presently, the distally based neurocutaneous flaps are the predominant surgical alternatives to free tissue transfer. In this article, we describe our experience with the distally based saphenous neurocutaneous flap for reconstructing soft tissue defects in this region.

Methods

A retrospective review of all patients who underwent reconstruction of the leg distal third and ankle joint at our department from January 1996 to June 2016 was carried out. Only patients who underwent reconstructive surgery for acute traumatic injuries were included. The fasciocutaneous pedicle was 3–4 cm wide, and the anatomical structures consisted of the superficial and deep fascia, saphenous nerve, greater saphenous vein and their accompanying vessels together with an islet of subcutaneous cellular tissue and skin. The size of skin islands ranged from 5–7 to 10–14 cm².

Results

A total of 170 patients (142 men and 28 women) were included in this study. The mean follow-up period was 3 months. All flaps survived with partial necrosis in three patients. Severe venous congestion occurred only in five patients. However, the flap was eventually salvaged after limb elevation and interrupted bloodletting. All donor sites were closed using split-skin grafting.

Conclusions

The reverse saphenous neurocutaneous flap proved to be a reliable and efficient method for reconstructing soft tissue defects in the distal third of the leg and ankle joint.

Level of Evidence: Level IV, therapeutic study

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