J Korean Orthop Assoc.  2008 Apr;43(2):234-239. 10.4055/jkoa.2008.43.2.234.

The Effects of Modified Design of the Reverse Superficial Sural Artery Flap

  • 1Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea. ljhortho@yahoo.or.kr


PURPOSE: To access the efficacy of a modified design of a reverse superficial sural artery flap (RSSAF) to decrease the level of venous congestion and flap necrosis.
Twenty four cases of RSSAF were performed. The mean age of the patients was 47 years and the mean follow up period was 21 months. The average size of the flap was 7.4x5.2 cm. There were 19 cases of the modified flap design and 5 cases of non-modified design. The venous congestion and complications were analyzed according to the modification of the flap design.
The flap survived in 23 cases. Primary closure of the donor site was performed in 11 cases whose flap width was <5 cm, and 12 cases required a skin graft. Venous congestion was observed in 5 cases including 4 cases, who were not treated with the modified design and 1 case with arterosclerosis obliterans preoperatively. Partial flap necrosis occurred in 2 flaps that did not have the modified design.
The modified RSSAF with a skin extension over the pedicle to decrease the tension of the tunnel is an effective procedure for reconstructing the lower extremity, which can prevent venous congestion and improve the survival rate of the flap.


Soft tissue defects; Low extremity; Modified design; Reverse superficial sural artery flap

MeSH Terms

Follow-Up Studies
Lower Extremity
Organic Chemicals
Survival Rate
Tissue Donors
Organic Chemicals


  • Fig. 1 (A) A 31-year-old man suffered a crushing injury on the heel and foot in a motor vehicle accident. (B) After debridement, there was a 10×6 cm defect, which resulted in exposure of the calcaneal bone on the heel. (C) The defect was covered with a reverse sural artery flap with tear drop skin design on the pedicle. The donor-site wound was managed successfully using a split-thickness skin graft. (D) The functional and cosmetic result was good.

  • Fig. 2 (A) A 52-year-old man was diagnosed with a malignant melanoma on the heel. After a wide excision, there was a 9×9cm defect. (B) The defect was covered with a reverse sural artery flap with a tear drop skin design on the pedicle. The donor-site defect was covered with a split-thickness skin graft. (C) The final result at 2 years was excellent.


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