Distally Based Saphenous Neurocutaneous Perforator Flap for Reconstructive Surgery in the Lower Leg and the Foot: A Long-Term Follow-Up Study of 70 Patients

Abstract

Background The management of soft-tissue defects in the distal third of the lower leg and foot remains disputed. In this article, we describe a long-term follow-up research study on the clinical results and complications of using this flap for the reconstruction of soft-tissue defects around the lower leg and foot.

Methods Between 2006 and 2008, 70 patients with soft-tissue defects around the lower leg and foot were treated with distally based saphenous neurocutaneous perforator flaps. The mean age of patients was 46.0 years (range, 22 to 70 years). An end point survey was performed after flap coverage; the mean follow-up was 54.2 months (range, 40 to 68 months), and response rate was 92.9% (65/70). A sensory morbidity was measured with a static two-point discrimination test and Semmes-Weinstein monofilament test.

Results A total of 58 flaps were survived completely, 6 flaps developed partial necrosis, and 1 experienced total failure. No severe venous congestion was observed and the skin grafts in the donor sites survived entirely. Sensitivity tests have shown an acceptable sensory recovery at the skin-grafted donor site and on the flap.

Conclusion Distally based saphenous neurocutaneous flap is a reliable and safe method for reconstruction of the defects around the lower leg and foot, with a lower sensorial morbidity.

Keywords

saphenous neurocutaneous flap - sensorial morbidity - long-term follow-up

• Reference

• 1 Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64 (3) 386-393
• 2 Cavadas PC. Reversed saphenous neurocutaneous island flap: clinical experience. Plast Reconstr Surg 1997; 99 (7) 1940-1946
• 3 Cavadas PC. Reversed saphenous neurocutaneous island flap: clinical experience and evolution to the posterior tibial perforator-saphenous subcutaneous flap. Plast Reconstr Surg 2003; 111 (2) 837-839
• 4 Zhang F, Zhang CC, Lin S, Zhang G, Zheng H. Distally based saphenous nerve-great saphenous veno-fasciocutaneous compound flap with nutrient vessels: microdissection and clinical application. Ann Plast Surg 2009; 63 (1) 81-88
• 5 Nenad T, Reiner W, Michael S, Reinhard H, Hans H. Saphenous perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 50 patients with posttraumatic osteomyelitis. J Trauma 2010; 68 (5) 1200-1207
• 6 Nakajima H, Imanishi N, Fukuzumi S , et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plast Reconstr Surg 1999; 103 (1) 104-120
• 7 Batchelor JS, McGuinness A. A reappraisal of axial and nonaxial lower leg fascial flaps: an anatomic study in human cadavers. Plast Reconstr Surg 1996; 97 (5) 993-1000
• 8 Nakajima H, Imanishi N, Fukuzumi S, Minabe T, Aiso S, Fujino T. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast Reconstr Surg 1998; 102 (3) 779-791
• 9 Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A. The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 1992; 90 (4) 643-649
• 10 Ozdemir R, Kocer U, Sahin B, Oruc M, Kilinc H, Tekdemir I. Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use. Plast Reconstr Surg 2006; 117 (5) 1619-1630
• 11 Stevanović G, Djordjević B, Daković M , et al. [Fasciocutaneous perforators of the lower leg—anatomic study and clinical significance]. Vojnosanit Pregl 2010; 67 (2) 136-144
• 12 Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985; 76 (3) 354-363
• 13 Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg 2005; 115 (3) 793-801
• 14 Wang CY, Chai YM, Wen G , et al. The free peroneal perforator-based sural neurofasciocutaneous flap: a novel tool for reconstruction of large soft-tissue defects in the upper limb. Plast Reconstr Surg 2011; 127 (1) 293-302
• 15 Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg 2007; 119 (6) 138e-148e
• 16 Karamürsel S, Celebioğlu S. Use of the medial side of the knee skin as a free flap: saphenous flap. Plast Reconstr Surg 2006; 117 (4) 1308-1314
• 17 Wong CH, Tan BK. Maximizing the reliability and safety of the distally based sural artery flap. J Reconstr Microsurg 2008; 24 (8) 589-594
• 18 Gideroglu K, Gunduz OH, Ofluoglu D, Akoz T. Sensorial donor site morbidity after saphenous neurocutaneous flap. Scand J Plast Reconstr Surg Hand Surg 2005; 39 (5) 302-307
• 19 Kelton Jr PL. Skin grafts and skin substitutes. Selected Readings in Plastic Surgery 1999; 9 (1) 1-24
• 20 Kimata Y, Uchiyama K, Ebihara S , et al. Comparison of innervated and noninnervated free flaps in oral reconstruction. Plast Reconstr Surg 1999; 104 (5) 1307-1313
• 21 Jeng C, Michelson J, Mizel M. Sensory thresholds of normal human feet. Foot Ankle Int 2000; 21 (6) 501-504
• 22 Zhuang YH, Zheng HP, Lin SQ, Xu DC. Vasculature at the medial aspect of the foot and clinical application of flaps based on it for forefoot reconstruction. Plast Reconstr Surg 2011; 127 (5) 1967-1978
• 23 Aydin OE, Tan O, Kuduban SD, Barin EZ. Nerve sparing-distally based sural flap. Microsurgery 2011; 31 (4) 276-280
• 24 Cordeiro PG, Schwartz M, Neves RI, Tuma R. A comparison of donor and recipient site sensation in free tissue reconstruction of the oral cavity. Ann Plast Surg 1997; 39 (5) 461-468
• 25 Teo T. Reconstrucción de la extremidad inferior con colgajos de perforantes locales. Cir Plast Iberlatinamer 2006; 32 (4) 287-292