title: Delayed distally based sural flap with temporary venous supercharging.
abstract: The distally based sural flap has become popular for reconstruction of the foot and leg. However, this flap often fails due to venous congestion. In this report, we developed a new modification of the distally based sural flap. The procedure comprised three stages. In the first stage, the flap was raised cephalad to the midpoint of the posterior aspect of the leg, involving reanastomosis of the short saphenous vein (SSV) at the proximal end of the flap. In the second stage, ligature of the SSV was performed. In the third stage, the entire flap was raised. We treated eight patients with the flap. All flaps survived completely. Duplex scanning indicated that venous drainage of the flap was provided by the tenuous venae comitantes (VCs) surrounding the SSV. Reanastomosis of the SSV may prevent rapid venous overloading of the VCs. Our new modification may be useful to avoid venous congestion.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. masaofuj@mth.biglobe.ne.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Matsushita
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Ohta
authors.initials: O
authors.lastname: Yusuke
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Fukamizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography / Q000379:methods; D015901:Angiography, Digital Subtraction / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods; D012039:Regional Blood Flow / Q000502:physiology; D018570:Risk Assessment; D012494:Sampling Studies; D012501:Saphenous Vein / Q000601:surgery / Q000637:transplantation*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013497:Sural Nerve; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome