title: Versatility of the distally-based sural artery fasciocutaneous flap on the lower leg and foot in patients with chronic disease.
abstract: BACKGROUND
  A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However, the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients.
  
  
  METHODS
  Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment.
  
  
  RESULTS
  The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1).
  
  
  CONCLUSIONS
  The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chonbuk National University School of Medicine, Jeonju, Korea.
authors.forename: Jin-Su
authors.initials: JS
authors.lastname: Park
authors.forename: Si-Gyun
authors.initials: SG
authors.lastname: Roh
authors.forename: Nae-Ho
authors.initials: NH
authors.lastname: Lee
authors.forename: Kyoung-Moo
authors.initials: KM
authors.lastname: Yang
keywords: Soft tissue injuries; Sural; Surgical flap