title: The modified reverse sural artery flap lower extremity reconstruction.
abstract: BACKGROUND
  The reverse sural artery flap eliminates the need for long and technically demanding free tissue transfers, which have become the gold standard for significant tissue defects in the distal third of the leg and ankle. Unfortunately, the originally described reverse sural artery flap technique has a risk of partial or total flap necrosis as high as 25%. We hypothesized that delaying the flap (the delay time ranged from 48 hours to 2 weeks) and using a 4-cm wide pedicle would decrease the amount of partial flap necrosis that commonly occurs with this flap.
  
  
  METHODS
  Five patients (3 women, 2 men) with open wounds in the distal lower extremity were treated with delayed fasciocutaneous reverse sural artery flaps elevated on a 4-cm wide pedicle.
  
  
  RESULTS
  The patients ranged from 22 to 75 years of age and had sustained defects in the ankle region resulting from trauma. All five wounds healed with favorable functional and asthetic results without any evidence of flap necrosis.
  
  
  CONCLUSIONS
  In patients with known vasculopathy, a surgical delay of 1 week and increasing the pedicle size to 4 cm may increase the likelihood of graft survival and decrease the amount of partial flap necrosis by dilating the arterial network.
authors.affiliation: Division of Plastic Surgery, Johns Hopkins Hospital; and the Division of Plastic Surgery, University of Maryland, Baltimore, Maryland, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Foran
authors.forename: Jeff
authors.initials: J
authors.lastname: Schreiber
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.forename: Nelson H
authors.initials: NH
authors.lastname: Goldberg
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors