title: Distal Based Sural Fascio-Cutaneous Flap: A Practical Limb Saviour for Wounds of War and Peace.
abstract: OBJECTIVE
  To determine the effect of mechanism of injury on wound healing, and on the viability and success of distally based sural flap when used for the coverage of defects of lower leg, ankle and foot.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Department of Surgery, Combined Military Hospital, Peshawar and Khariyan, from January 2012 to December 2014.
  
  
  METHODS
  Patients with soft tissue defects over the distal leg, ankle and foot were selected by purposive sampling technique and divided into 2 groups of 19 patients each. Group A(road traffic accidents) and group B (war injuries). Sural fascio-cutaneous flap was the reconstructive tool used in all the cases using single technique by the same surgical team; and time for recipient site preparation, size of the defect, graft survival, its healing time and complications, were studied.
  
  
  RESULTS
  The mean age of the 38 patients in the study was 28.2 ±13.4 years. There were 36 male and 2 female patients. The most common site of injury encountered was leg (n=20) followed by foot (n=11) and ankle (n=5). Maximum wound size seen in group A was 10 x 12 cm and in group B was 15 x 38 cm. Recovery was uneventful in 17/19 cases of group Awhile 7/19 in group B and with no graft failure. Superficial epidermolysis was seen in 2 and 8 cases in group A and B respectively while edge necrosis of the flap was observed in group B only (n=4). Healing time on average was 2 to 3 weeks in group A, and 4 to 5 weeks in group B.
  
  
  CONCLUSIONS
  Soft tissue defects of the distal lower extremity as a result of war injuries and road traffic accidents have different dynamics in terms of wound size, time of wound healing, wound complications and functional outcome; but distal based sural flap has promising results in both situations.
authors.affiliation: Department of General Surgery, 3 Mtn Med Bn FTC Bhimber, Azad Jammu and Kashmir.
authors.forename: M Uzair
authors.initials: MU
authors.lastname: Ilyas Tahirkheli
authors.affiliation: Department of General and Plastic Surgery, Combined Military Hospital, Khariyan.
authors.forename: Irfan
authors.initials: I
authors.lastname: Ellahi
authors.affiliation: Department of General and Plastic Surgery, Combined Military Hospital, Khariyan.
authors.forename: Muhammad Farooq
authors.initials: MF
authors.lastname: Dar
authors.affiliation: Department of General Surgery, Combined Military Hospital, Pano Aqil.
authors.forename: Arslan
authors.initials: A
authors.lastname: Sharif
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D001753:Blast Injuries; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery; D013497:Sural Nerve / Q000098:blood supply*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult