The use of the reverse sural neurovenocutaneous flap in distal tibia, ankle and heel reconstruction

The distal third of the tibia, ankle and heel area is difficult to reconstruct. Microsurgery is an option but the time and the complexity of this type of procedure is a disadvantage. For small to medium size defects, local flaps are often an easier alternative. Recent detailed anatomic studies have demonstrated the existence of the perineural vascular plexus. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. Many articles have been written with some contrasting opinions regarding the anatomy, size of flap, location of the skin paddle, mode of transfer and overall survival. The aim of this publication is to present a single surgeon’s experience in 17 consecutive cases using the reverse sural flap for distal tibia, ankle and heel reconstruction. The location of the defect, the flap dimensions, the results and complications are presented. Some conclusions are drawn and recommendations are made for maximum efficacy when using this flap, especially when used in older patients.