title: Venous Supercharging Reduces Complications and Improves Outcomes of Distally Based Sural Flaps.
abstract: BackgroundThe use of distally based neurocutaneous sural flaps (DBNCSF) is one of the most common methods of reconstructing the distal lower leg. However, they have developed a bad reputation because of their propensity for venous engorgement. Venous congestion that can lead to distal necrosis can be prevented by venous supercharging. Using a prospective comparative study, we thus explored the effect of venous supercharging on the reliability of these useful workhorse flaps.MethodsWe prospectively included 38 patients who received a conventional DBNCSF and 38 patients who received a supercharged version of this flap (sDBNCSF) between January 2012 and July 2016.ResultsNo significant difference was identified between the groups in terms of age, sex, comorbidity, or defect origin. The main reconstruction etiology was traumatic (open fracture, scar disunion, and chronic osteitis). The flap size was noticeably larger in the sDBNCSF group, albeit without significance. The length-width ratio was significantly greater in the sDBNCSF group (6.08 vs. 5.53,p= 0.022). Venous congestion was significantly more common in the non-supercharged group (28.6 vs. 2.6%,p= 0.01), as was coverage failure (23.7 vs. 2.6%,p= 0.035).ConclusionThere are significant benefits to using venous supercharging of DBNCSF, when technically feasible. In our experience, venous supercharging increases reliability, allows the raise of larger skin paddles with much narrower pedicles limiting the morbidity of the procedure, and improves the functional and esthetic results.
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France.|Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France.|Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, South University Hospital, Rennes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bertheuil
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle Hospital, Rouen, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Carloni
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France.
authors.forename: Sandy
authors.initials: S
authors.lastname: Dast
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Picardie, Amiens, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Sinna
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rangueil, Toulouse, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Chaput
mesh_terms: D000328:Adult; D000792:Angiography; D003646:Debridement; D005260:Female; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D016896:Treatment Outcome