title: Is it safe to extract the reverse sural artery flap from the proximal third of the leg?
abstract: BACKGROUND
  The reversed sural artery flap is a well-described method for lower limb reconstruction. However, in the standard technique, the flap is usually not harvested from the proximal third of the leg. We conducted this study to evaluate the efficiency, safety, and success rate of the reversed sural flap harvested from the proximal third of the leg.
  
  
  METHODS
  The authors harvested medium to very large sized flaps from or extended to the upper third of the calf in 28 patients to cover the defects in the distal tibia, ankle, heel, foot, and sole.
  
  
  RESULTS
  With proximal extension of the flap, we would have a longer and larger flap with a safer pedicle. The majority of flaps resulted in a good coverage of defects. Only the distal 1cm of a large flap developed marginal necrosis in the distal border, which was treated with a secondary skin graft. Six flaps developed venous congestion. In seven other patients, minor complications such as hypertrophic scar in the donor site, rupture of sutures, and superficial epidermolysis occurred. In these 13 patients, the complications did not influence the final outcome.
  
  
  CONCLUSIONS
  Extension of reversed sural island flap to the proximal third of the leg was safe and reliable. It was efficiently used to treat patients with large and far wounds, from the distal leg to the distal foot and the sole with more versatility and easier reach to the recipient site.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. esmail_hassanpour@yahoo.com
authors.forename: Seyed-Esmail
authors.initials: SE
authors.lastname: Hassanpour
authors.forename: Naser
authors.initials: N
authors.lastname: Mohammadkhah
authors.forename: Ehsan
authors.initials: E
authors.lastname: Arasteh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome