title: The Distally Based Sural Flap for the Reconstruction of Ankle and Foot Defects in Pediatric Patients.
abstract: BACKGROUND
  Skin and soft tissue defects at the level of the ankle and the heel remain a great challenge for plastic and reconstructive surgeons. There were just a few reports on the use of distal-based sural flap in pediatric patients. The purpose of this study was to introduce our experience in the treatment of skin and soft tissue defects of the pediatric feet by using this distally based sural neurocutaneous flap together with some technical modifications for a large-sized defect.
  
  
  METHODS
  From July 2004 to October 2012, a total of 36 children younger than 12 years were treated with distally based sural flap for a variety of soft tissue defects of the foot and the ankle. All patients experienced a traffic accident. Thirty-four patients received standard distal-based reverse sural flaps, and 2 children received the flaps with nerve and vein sparing.
  
  
  RESULTS
  The duration of follow-up varied from 3 to 48 months. All flaps survived completely. Two flaps presented vascular insufficiency and resulted in partial distal superficial necrosis (10%-20%). Two children had a compressive ulcer because of improper shoes wearing. There were no complaints related to the killing of the sural nerve.
  
  
  CONCLUSIONS
  The distally based sural flap is an excellent choice in pediatric patients for covering defects of the lower leg and the foot because of its simplicity, versatility, low risk, and minimal donor site morbidity.
authors.affiliation: From the *Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and †Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Huaiyuan
authors.initials: H
authors.lastname: Zheng
authors.forename: Juan
authors.initials: J
authors.lastname: Liu
authors.forename: Xinyi
authors.initials: X
authors.lastname: Dai
authors.forename: Arndt F
authors.initials: AF
authors.lastname: Schilling
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013497:Sural Nerve / Q000601:surgery*; D013524:Surgical Flaps / Q000294:innervation*; D016896:Treatment Outcome