title: Reverse sural flap with an adipofascial extension for reconstruction of soft tissue defects with dead spaces in the heel and ankle.
abstract: BACKGROUND
  The reconstruction of soft tissue defects with dead spaces in the heel and ankle is challenging. This article describes our experience in the reconstruction of such defects using the reverse sural flap with an adipofascial extension.
  
  
  METHODS
  Reverse sural flaps with an adipofascial extension were used in 26 patients with soft tissue defects in the heel (n = 24) or ankle (n = 2). Extended adipofascial tissue was utilized to fill the dead space. The sizes of the adipofascial extensions varied from 2.0 to 5.0 cm in length and 4.0 to 12.5 cm in width.
  
  
  RESULTS
  Twenty-three flaps survived completely, and lateral marginal necrosis occurred in three flaps. All the recipient-site wounds healed without any signs of infection. The reconstruction outcomes were excellent in 20 patients and good in 6 patients according to the criteria of Boyden et al.
  
  
  CONCLUSIONS
  The extended adipofascial tissue of the reverse sural flap improves closure of the dead spaces in soft tissue defects of the heel and ankle and thus provides beneficial conditions for the treatment of infection and reconstruction of both the function and contour of the soft tissue defects with dead spaces in the heel and ankle.
authors.affiliation: Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, People's Republic of China. lzheng@kleinertkutz.com.|Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Care Center, 225 Abraham Flexner Way, Suite 850, Louisville, KY, 40202, USA. lzheng@kleinertkutz.com.|Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, 40202, USA. lzheng@kleinertkutz.com.
authors.forename: L
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
authors.forename: Z G
authors.initials: ZG
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000842:Ankle / Q000601:surgery*; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D000072226:Computed Tomography Angiography; D005260:Female; D058752:Free Tissue Flaps; D006365:Heel / Q000293:injuries* / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D018608:Ultrasonography, Doppler; D016474:Weight-Bearing; D014945:Wound Healing; D055815:Young Adult
keywords: Adipofascial tissue; Heel; Soft tissue defect; Sural flap; Surgical flap