title: Should we hesitate to use subcutaneous tunneling for fear of damaging the sural flap pedicle?
abstract: BACKGROUND
  The distally based sural nerve flap is a preferable option for covering defects of the lower third of the leg. However, many authors noted that in particular pressure exerted by tunneling of the flap pedicle could be harmful. Thus, they either inset the pedicle or exteriorize the pedicle to decrease complications.
  
  
  METHODS
  We used distally based superficial sural artery island flaps for the reconstruction of defects of the lower leg, the ankle, and malleolus in 12 patients between 2004 and 2008 without tunelization. The defects were covered with no major complications.
  
  
  RESULTS
  In 3 flaps, there was a small amount of distal marginal necrosis, which was excised and closed spontaneously or skin grafted.
  
  
  CONCLUSIONS
  We concluded that unless there are certain risk factors such as arterial hypertension, diabetes, peripheral vascular disease, and vasculitis, avoiding a subcutaneous tunneling is not necessary.
authors: Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy and Medical Faculty, Haydarpasa Training Hospital, Istanbul, Turkey. fatihuygur@hotmail.com
authors: Fatih
authors: F
authors: Uygur
authors: Rahmi
authors: R
authors: Evinç
authors: Nurettin
authors: N
authors: Noyan
authors: Haluk
authors: H
authors: Duman
mesh_terms: D000328:Adult; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology*; D016038:Skin Transplantation; D012983:Soft Tissue Neoplasms / Q000601:surgery; D040521:Subcutaneous Tissue / Q000601:surgery*; D013497:Sural Nerve / Q000637:transplantation*; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology; D055815:Young Adult