title: [The distally based adipofascial sural artery flap for the reconstruction of distal lower extremity defects].
abstract: OBJECTIVE
  Problematic tissue defects in the distal one-third of the lower leg represent a special challenge for the operative therapy. The distally based adipofascial sural artery flap is a safe and effective modification of the classical fasciocutaneous sural artery flap technique and makes the reconstruction in this problematic area more feasible. The surgical aim is soft tissue reconstruction with local tissue avoiding free tissue transfer.
  
  
  METHODS
  Complex or chronic wounds (maximum width of 8 cm) of the distal lower leg with exposed bone, joints, tendons, and/or neurovascular structures, especially in cases of missing skin perforators.
  
  
  METHODS
  Arterial vascular disease (stage III-IV), especially peroneal artery occlusion. Postthrombotic syndrome with occlusion of the small saphenous vein. Chronic lymphedema.
  
  
  METHODS
  Preparation of the vascular pedicle of the distally based flap (including small saphenous vein, sural artery and nerve), the adjacent crural fascia and the subcutaneous fat without a skin island. The pivot point is about 6 cm cranial to the malleolus lateralis. The flap can be raised proximally up to the heads of the gastrocnemius muscle. After harvesting the flap there will be a change in blood flow direction in the small saphenous vein. The donor site can be closed primarily. The flap is covered with meshed split skin graft at the end of surgery.
  
  
  METHODS
  Strict elevation of the extremity for 5 days, then flap conditioning.
  
  
  RESULTS
  Between 1997 and 2012, this technique was used in 104 consecutive patients with soft tissue defects in the distal one-third of the lower leg. Flap survival was achieved 91 patients. In 2 patients amputation of the lower leg was necessary at the mid tibia level. In 3 cases flap necrosis occurred, requiring free tissue transfer.
authors.affiliation: Division of plastic and aesthetic surgery and handsurgery, Department of traumatology, Julius Maximilians Universtity of Würzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Deutschland. Schmidt_k@klinik.uni-wuerzburg.de
authors.forename: K
authors.initials: K
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Jakubietz
authors.forename: P
authors.initials: P
authors.lastname: Harenberg
authors.forename: B M
authors.initials: BM
authors.lastname: Holzapfel
authors.forename: M
authors.initials: M
authors.lastname: Rudert
authors.forename: R
authors.initials: R
authors.lastname: Meffert
authors.forename: R
authors.initials: R
authors.lastname: Jakubietz
mesh_terms: D000328:Adult; D001158:Arteries / Q000637:transplantation*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D061525:Perforator Flap / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D050151:Subcutaneous Fat / Q000637:transplantation*; D016896:Treatment Outcome