title: Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients.
abstract: OBJECTIVE
  Reconstructing defects related to the leg soft tissue may be quite difficult because the soft tissue over the bone is rather thin and the tendons lie right under the skin. Distal pedicle sural neurocutaneous flap with its long pedicle composed of skin, subcutaneous tissue and fascia is suitable for superficial defects. This study aimed to determine the usability of the delayed reverse-flow (distally based) islanded sural flap for correcting tibial and ankle defects.
  
  
  METHODS
  A prospective clinical trial conducted from 2012 to 2013 in Plastic & Reconstructive and Aesthetic Surgery clinic, Necmettin Erbakan University, Turkey.
  
  
  METHODS
  Eleven patients with pretibial defects and a visible open bone who underwent reconstruction with reverse-flow islanded sural flap between 2012 and 2013 were included in the study. All patients who had defects between the middle of the tibia and the foot underwent surgery in 2 sessions under spinal anesthesia. In the first session, necrotic tissues were debrided and cultures were taken, and the flap was delayed. Reconstruction was performed in the second session.
  
  
  RESULTS
  The biggest flap was 16.11 cm and the smallest one was 5.6 cm. The longest pedicle was 27 cm long and the shortest one 21 cm. A total of 6 patients were smokers and 3 had diabetes mellitus. One patient had partial necrosis of the flap, and the necrosis was healed secondarily. No complications were seen in other patients.
  
  
  CONCLUSIONS
  Delayed reverse-flow islanded sural flaps can be used as an easy, quick, and secure surgical alternative to free flaps for correcting in leg defects involving an exposed bone between the middle portion of the tibia and the heel.
authors.affiliation: Bilsev Ince, Department of Plastic,, Reconstructive and Aesthetic Surgery,, Faculty of Meram Medicine,, Necmettin Erbakan University,, Konya 42080 Turkey, T: +905552776488, bilsevince@yahoo.com.
authors.forename: Bilsev
authors.initials: B
authors.lastname: Ince
authors.forename: Mehmet
authors.initials: M
authors.lastname: Daaci
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Altuntas
authors.forename: Tugba
authors.initials: T
authors.lastname: Sodali
authors.forename: Fatma
authors.initials: F
authors.lastname: Bilgen
authors.forename: Mustafa Kursat
authors.initials: MK
authors.lastname: Evrenos
mesh_terms: D000328:Adult; D000761:Anesthesia Department, Hospital / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007869:Leg Injuries / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000473:pathology / Q000601:surgery*; D013497:Sural Nerve; D013524:Surgical Flaps; D013977:Tibia; D014421:Turkey; D055815:Young Adult