title: [The one- and two-stage distally pedicled sural flap : surgical technique and clinical results].
abstract: BACKGROUND
  The distally pedicled suralis flap is used to cover local defects of the distal lower leg, ankle and hind foot. It is a local flap with no need for microvascular anastomosis, a constant blood supply and ease of elevation. Disadvantages are lack of sensation, donor site morbidity and venous congestion.
  
  
  METHODS
  This study includes 25 patients. Apart from the defect extent, cause and location, complications were also determined.
  
  
  RESULTS
  The defect site was located in the hind foot in 5 cases and the distal lower leg in 14 cases. In four patients the soft tissue of the lateral calcaneal region and in two cases the sole of the foot were affected. Severe venous congestion, which was only detected in 180° turned flaps, was seen in five cases. In five patients we successfully performed a two-stage flap transposition procedure to avoid venous congestion.
  
  
  CONCLUSIONS
  The sural flap remains a reliable solution for soft tissue defects. Under inappropriate circumstances (small pedicle or severe torque of pedicle) venous congestion or even thrombosis is possible. A two-stage approach with conditioning of venous drainage can have a positive effect on these problems.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Deutschland. oliver.weber@ukb.uni-bonn.de
authors.forename: O
authors.initials: O
authors.lastname: Weber
authors.forename: G
authors.initials: G
authors.lastname: Pagenstert
authors.forename: S
authors.initials: S
authors.lastname: Gravius
authors.forename: C
authors.initials: C
authors.lastname: Burger
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.forename: P
authors.initials: P
authors.lastname: Pennekamp
authors.forename: M
authors.initials: M
authors.lastname: Martini
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult