title: Sural perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 86 patients with post-traumatic osteomyelitis.
abstract: BACKGROUND
  The treatment of post-traumatic osteomyelitis of the lower leg and the foot remains a challenge in reconstructive surgery.
  
  
  METHODS
  Eighty-six patients with lower leg post-injury chronic osteomyelitis were included in a retrospective, non-controlled clinical study conducted from 1995 to 2006. All study patients were managed by distally based sural neuro-fascio-cutaneous perforator flap. An endpoint survey was conducted after flap surgery and had a mean follow-up period of 5.5 years, wherein the response rate was 48%.
  
  
  RESULTS
  Seven patients had a short-term flap failure (8%; 95% CI 3-16%). An additional eight patients (7%) had flap necrosis of less than one-fourth of the flap that healed without surgical revision. Based on the endpoint data, the long-term success rate was 87% (95%, CI 72-96%). Local and/or systemic physiological compromise was a risk factor for flap failure. Other assumed risk factors had no statistically significant impact on short- or long-term results.
  
  
  CONCLUSIONS
  Sural perforator flap is a robust flap with low failure rate, even in high-risk patients. The success rate compares favourably with results of free flap transfers in the management of post-traumatic osteomyelitis. The flap has a wide range, and the surgical technique is rather simple. The sural flap is a feasible option for post-traumatic reconstructions of osteomyelitis, especially in low-resource settings.
authors.affiliation: Department of Surgery, Institute of Clinical Medicine, University of Tromso, PO Box 80, University Hospital North Norway, Norway.
authors.forename: N
authors.initials: N
authors.lastname: Tajsiç
authors.forename: R
authors.initials: R
authors.lastname: Winkel
authors.forename: R
authors.initials: R
authors.lastname: Hoffmann
authors.forename: H
authors.initials: H
authors.lastname: Husum
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000150:complications; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D017211:Treatment Failure