Skip to main content
Top
Published in: BMC Surgery 1/2021

Open Access 01-12-2021 | Skin Graft | Research article

Reliability of distally based sural flap in elderly patients: comparison between elderly and young patients in a single center

Authors: Ping Peng, Zhonggen Dong, Jianwei Wei, Lihong Liu, Zhaobiao Luo, Shu Cao

Published in: BMC Surgery | Issue 1/2021

Login to get access

Abstract

Background

Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients (≥ 60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients.

Methods

Between March of 2005 and December of 2019, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥ 60 years old) and group B (ranging from 18 to 30 years old).

Results

The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05).

Conclusions

The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary.
Literature
1.
go back to reference Lee YK, Lee M. Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient: a case report. Medicine (Baltimore). 2018;97:e11995.CrossRef Lee YK, Lee M. Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient: a case report. Medicine (Baltimore). 2018;97:e11995.CrossRef
2.
go back to reference Mb O, Aksan T, Ertekin C, Tezcan M. Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications. Int Wound J. 2020;17:429–35.CrossRef Mb O, Aksan T, Ertekin C, Tezcan M. Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications. Int Wound J. 2020;17:429–35.CrossRef
3.
go back to reference Han Y, Han YD, Song BQ, Guo LL, Tao R, Chai M. Free medial plantar flap versus free dorsal myocutaneous flap for the reconstruction of traumatic foot sole defects. Ann Plast Surg. 2020;84:S178–85.CrossRef Han Y, Han YD, Song BQ, Guo LL, Tao R, Chai M. Free medial plantar flap versus free dorsal myocutaneous flap for the reconstruction of traumatic foot sole defects. Ann Plast Surg. 2020;84:S178–85.CrossRef
4.
go back to reference Fu DH, Zhou LY, Yang SH, Xiao BJ. Surgical technique: repair of forefoot skin and soft tissue defects using a lateral tarsal flap with a reverse dorsalis pedis artery pedicle: a retrospective study of 11 patients. Clin Orthop Relat Res. 2013;471:317–23.CrossRef Fu DH, Zhou LY, Yang SH, Xiao BJ. Surgical technique: repair of forefoot skin and soft tissue defects using a lateral tarsal flap with a reverse dorsalis pedis artery pedicle: a retrospective study of 11 patients. Clin Orthop Relat Res. 2013;471:317–23.CrossRef
5.
go back to reference Kozak GM, Hsu JY, Broach RB, et al. Comparative effectiveness analysis of complex lower extremity reconstruction: outcomes and costs for biologically based, local tissue rearrangement, and free flap reconstruction. Plast Reconstr Surg. 2020;145:608e–16e.CrossRef Kozak GM, Hsu JY, Broach RB, et al. Comparative effectiveness analysis of complex lower extremity reconstruction: outcomes and costs for biologically based, local tissue rearrangement, and free flap reconstruction. Plast Reconstr Surg. 2020;145:608e–16e.CrossRef
6.
go back to reference Ozkan O, Ozgentas HE, Islamoglu K, Boztug N, Bigat Z, Dikici MB. Experiences with microsurgical tissue transfers in elderly patients. Microsurgery. 2005;25:390–5.CrossRef Ozkan O, Ozgentas HE, Islamoglu K, Boztug N, Bigat Z, Dikici MB. Experiences with microsurgical tissue transfers in elderly patients. Microsurgery. 2005;25:390–5.CrossRef
7.
go back to reference Herold C, Gohritz A, Meyer-Marcotty M, et al. Is there an association between comorbidities and the outcome of microvascular free tissue transfer? J Reconstr Microsurg. 2011;27:127–32.CrossRef Herold C, Gohritz A, Meyer-Marcotty M, et al. Is there an association between comorbidities and the outcome of microvascular free tissue transfer? J Reconstr Microsurg. 2011;27:127–32.CrossRef
8.
go back to reference Turrà F, La Padula S, Razzano S, et al. Microvascular free-flap transfer for head and neck reconstruction in elderly patients. BMC Surg. 2013; null:S27. Turrà F, La Padula S, Razzano S, et al. Microvascular free-flap transfer for head and neck reconstruction in elderly patients. BMC Surg. 2013; null:S27.
9.
go back to reference Liu ZL, Tian ZW, Zhang CP, Sun J, Zhang ZY, He Y. Microvascular reconstruction in elderly oral cancer patients: does diabetes status have a predictive role in free flap complications? J Oral Maxillofac Surg. 2015;73:357–69.CrossRef Liu ZL, Tian ZW, Zhang CP, Sun J, Zhang ZY, He Y. Microvascular reconstruction in elderly oral cancer patients: does diabetes status have a predictive role in free flap complications? J Oral Maxillofac Surg. 2015;73:357–69.CrossRef
10.
go back to reference Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience. Plast Reconstr Surg. 1992;89:1115–21.CrossRef Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience. Plast Reconstr Surg. 1992;89:1115–21.CrossRef
11.
go back to reference Eser C, Gencel E, Kesiktaş E, Kokaçya Ö, Yavuz M. A convenient flap for repairing the donor area of a distally based sural flap: gastrocnemius perforator island flap. J Plast Reconstr Aesthet Surg. 2016;69:1109–15.CrossRef Eser C, Gencel E, Kesiktaş E, Kokaçya Ö, Yavuz M. A convenient flap for repairing the donor area of a distally based sural flap: gastrocnemius perforator island flap. J Plast Reconstr Aesthet Surg. 2016;69:1109–15.CrossRef
12.
go back to reference Olawoye OA, Ademola SA, Iyun K, Michael A, Oluwatosin O. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Int Wound J. 2014;11:210–4.CrossRef Olawoye OA, Ademola SA, Iyun K, Michael A, Oluwatosin O. The reverse sural artery flap for the reconstruction of distal third of the leg and foot. Int Wound J. 2014;11:210–4.CrossRef
13.
go back to reference Wei JW, Ni JD, Dong ZG, Liu LH, Luo ZB, Zheng L. Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg, ankle, and foot: comparison between pediatric and adult patients. J Reconstr Microsurg. 2014;30:249–54.CrossRef Wei JW, Ni JD, Dong ZG, Liu LH, Luo ZB, Zheng L. Distally based perforator-plus sural fasciocutaneous flap for soft-tissue reconstruction of the distal lower leg, ankle, and foot: comparison between pediatric and adult patients. J Reconstr Microsurg. 2014;30:249–54.CrossRef
14.
go back to reference Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg. 2003;112:129–40 (discussion 141-2).CrossRef Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg. 2003;112:129–40 (discussion 141-2).CrossRef
15.
go back to reference Parrett BM, Pribaz JJ, Matros E, Przylecki W, Sampson CE, Orgill DP. Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction. Plast Reconstr Surg. 2009;123:1499–504.CrossRef Parrett BM, Pribaz JJ, Matros E, Przylecki W, Sampson CE, Orgill DP. Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction. Plast Reconstr Surg. 2009;123:1499–504.CrossRef
16.
go back to reference de Blacam C, Colakoglu S, Ogunleye AA, et al. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis. J Plast Reconstr Aesthet Surg. 2014;67:607–16.CrossRef de Blacam C, Colakoglu S, Ogunleye AA, et al. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis. J Plast Reconstr Aesthet Surg. 2014;67:607–16.CrossRef
17.
go back to reference Dong ZG, Wei JW, Ni JD, et al. Anterograde-retrograde method for harvest of distally based sural fasciocutaneous flap: report of results from 154 patients. Microsurgery. 2012;32:611–6.CrossRef Dong ZG, Wei JW, Ni JD, et al. Anterograde-retrograde method for harvest of distally based sural fasciocutaneous flap: report of results from 154 patients. Microsurgery. 2012;32:611–6.CrossRef
18.
go back to reference Wei JW, Dong ZG, Ni JD, et al. Influence of flap factors on partial necrosis of reverse sural artery flap: a study of 179 consecutive flaps. J Trauma Acute Care Surg. 2012;72:744–50.CrossRef Wei JW, Dong ZG, Ni JD, et al. Influence of flap factors on partial necrosis of reverse sural artery flap: a study of 179 consecutive flaps. J Trauma Acute Care Surg. 2012;72:744–50.CrossRef
19.
go back to reference Bhadkamkar MA, Wolfswinkel EM, Hatef DA, et al. The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg. 2014;30:599–606.CrossRef Bhadkamkar MA, Wolfswinkel EM, Hatef DA, et al. The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg. 2014;30:599–606.CrossRef
20.
go back to reference Qing LM, Wu PF, Yu F, Zhou ZB, Tang JY. Use of a sequential chimeric perforator flap for one-stage reconstruction of complex soft tissue defects of the extremities. Microsurgery. 2020;40:167–74.CrossRef Qing LM, Wu PF, Yu F, Zhou ZB, Tang JY. Use of a sequential chimeric perforator flap for one-stage reconstruction of complex soft tissue defects of the extremities. Microsurgery. 2020;40:167–74.CrossRef
21.
go back to reference Gao WY, Hong JJ, Li ZJ, Chen XL. Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle. Microsurgery. 2008;28:355–60.CrossRef Gao WY, Hong JJ, Li ZJ, Chen XL. Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle. Microsurgery. 2008;28:355–60.CrossRef
22.
go back to reference Blondeel PN, Van LKHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–83 (quiz 1383, 1516; discussion 1384-7).CrossRef Blondeel PN, Van LKHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–83 (quiz 1383, 1516; discussion 1384-7).CrossRef
23.
go back to reference Wähmann M, Wähmann M, Henn D, et al. Geriatric patients with free flap reconstruction: a comparative clinical analysis of 256 cases. J Reconstr Microsurg. 2020;36:127–35.CrossRef Wähmann M, Wähmann M, Henn D, et al. Geriatric patients with free flap reconstruction: a comparative clinical analysis of 256 cases. J Reconstr Microsurg. 2020;36:127–35.CrossRef
24.
go back to reference Hanken H, Barsukov E, Göhler F, et al. Analysis of outcome for elderly patients after microvascular flap surgery: a monocentric retrospective cohort study. Clin Oral Investig. 2020;24:193–200.CrossRef Hanken H, Barsukov E, Göhler F, et al. Analysis of outcome for elderly patients after microvascular flap surgery: a monocentric retrospective cohort study. Clin Oral Investig. 2020;24:193–200.CrossRef
25.
go back to reference Ince B, Daaci M, Altuntas Z, Sodali T, Bilgen F, Evrenos MK. Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients. Ann Saudi Med. 2014;34:235–40.CrossRef Ince B, Daaci M, Altuntas Z, Sodali T, Bilgen F, Evrenos MK. Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients. Ann Saudi Med. 2014;34:235–40.CrossRef
26.
go back to reference Roberts HJ, DeSilva GL. Can sural fasciocutaneous flaps be effective in patients older than 65? Clin Orthop Relat Res. 2020;478:734–8.CrossRef Roberts HJ, DeSilva GL. Can sural fasciocutaneous flaps be effective in patients older than 65? Clin Orthop Relat Res. 2020;478:734–8.CrossRef
27.
go back to reference Kneser U, Bach AD, Polykandriotis E, Kopp J, Horch RE. Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast Reconstr Surg. 2005;116:1910–7.CrossRef Kneser U, Bach AD, Polykandriotis E, Kopp J, Horch RE. Delayed reverse sural flap for staged reconstruction of the foot and lower leg. Plast Reconstr Surg. 2005;116:1910–7.CrossRef
28.
go back to reference Chang SM, Wang X, Huang YG, Zhu XZ, Tao YL, Zhang YQ. Distally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique. Ann Plast Surg. 2014;72:340–5.CrossRef Chang SM, Wang X, Huang YG, Zhu XZ, Tao YL, Zhang YQ. Distally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique. Ann Plast Surg. 2014;72:340–5.CrossRef
29.
go back to reference Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg. 2007;119(02):590–8.CrossRef Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg. 2007;119(02):590–8.CrossRef
Metadata
Title
Reliability of distally based sural flap in elderly patients: comparison between elderly and young patients in a single center
Authors
Ping Peng
Zhonggen Dong
Jianwei Wei
Lihong Liu
Zhaobiao Luo
Shu Cao
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Skin Graft
Published in
BMC Surgery / Issue 1/2021
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-021-01175-6

Other articles of this Issue 1/2021

BMC Surgery 1/2021 Go to the issue