title: Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis.
abstract: The distally based sural fasciocutaneous flap is one of the few options available for local flap reconstruction of soft-tissue defects in the lower one-third of the leg. Few studies have assessed risk factors associated with poor outcomes in this flap. A literature search was performed of MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles evaluating the use of sural artery fasciocutaneous flaps for soft-tissue reconstruction of the leg. Data were pooled and a univariate analysis was performed to identify characteristics associated with increased morbidity. A logistic regression model was created, and odds ratios and p values associated with the development of complications were calculated. Sixty-one papers were identified which included data on 907 patients. The majority of sural flaps were used to cover defects of the heel (28.2%), foot (14.4%) or ankle (25.8%). Trauma was the most common indication, followed by ulcers and open fractures. Flap complications were recorded in 26.4% of cases with a flap loss rate of 3.2%. With multivariate analysis, venous insufficiency and increasing age were independent risk factors for complications. Patients with venous insufficiency had nine times the risk of developing a complication compared to patients without venous insufficiency.
authors.affiliation: Plastic Surgery Higher Surgical Training Scheme, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: de Blacam
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.affiliation: Department of Surgery, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Adeyemi A
authors.initials: AA
authors.lastname: Ogunleye
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: blee3@bidmc.harvard.edu.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D016512:Ankle Injuries / Q000601:surgery; D018409:Foot Injuries / Q000601:surgery; D006801:Humans; D007871:Leg Ulcer / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D014689:Venous Insufficiency / Q000150:complications*
keywords: Distally based sural flap; Lower-extremity reconstruction; Sural flap