title: Risk analysis for the reverse sural fasciocutaneous flap in distal leg reconstruction.
abstract: BACKGROUND
  The reverse sural fasciocutaneous flap provides the potential for simple and efficient closure of distal leg, ankle, and foot defects. In young patients with traumatic injuries, low complication rates have been reported. The authors hypothesize that extending its use to older patients with comorbidities results in a higher complication rate.
  
  
  METHODS
  The authors retrospectively reviewed 58 consecutive reverse sural fasciocutaneous flap in 57 patients for distal leg reconstruction. Outcomes were compared between patients with no comorbidities (n = 31) and those with a history of smoking, diabetes mellitus, or peripheral arterial disease (n = 26). Standard statistical analyses were performed, including logistic regression.
  
  
  RESULTS
  Patients had a mean age of 53 years and a median follow-up of 20 months. Fifty percent of flaps had postoperative complications, with nine (16 percent) major complications (three total flap losses and six partial losses), 17 (29 percent) minor complications, and three infections. In patients without comorbidities, there were no major complications and five minor complications (16 percent). Significantly higher major and minor complication rates were seen in older patients and patients with a history of smoking, obesity, diabetes, or peripheral arterial disease. Multivariate regression analysis identified smoking as the risk factor most independently associated with any reverse sural fasciocutaneous flap complication. Importantly, surgical delay procedures were associated with decreased ischemic flap complications in patients with comorbidities.
  
  
  CONCLUSIONS
  Although the reverse sural fasciocutaneous flap is reliable in young healthy patients, it has significant complication rates in patients with comorbidities, especially smokers. In such patients, the reverse sural fasciocutaneous flap requires multiple operative revisions and a surgical delay should be considered.
authors.affiliation: Boston, Mass. From the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Parrett
authors.forename: Julian J
authors.initials: JJ
authors.lastname: Pribaz
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.forename: Wojtek
authors.initials: W
authors.lastname: Przylecki
authors.forename: Christian E
authors.initials: CE
authors.lastname: Sampson
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D055815:Young Adult