Razi Journal of Medical Sciences

Background: A sural artery flap is a fasciocutaneous one based on the reverse blood flow and the anastomosis between the superficial sural artery and the perforators of peroneal artery. This flap is used in order to reconstruct the soft tissue defects of the distal leg, ankle and heel and also to cover the vessels, tendons and bones. It is possible to cover the defects in size 10*12 cm with this flap, classically; as well, the design of the flap is being done by the limited shapes such as L and T-shaped. The purpose of this article is to introduce the new design of this flap to creating the most level of consistency with the shape of the defect.

Method: The patient was a twelve year old girl who faced a large defect and the separation of the soft tissue of the heel and ankle of the right foot by an accident with a motorcycle about three weeks prior to her referral as her medial malleolus and Achilles tendon were exposed. Then, after the first reconstruction in the orthopedically services, she faced severe necrosis of tissue and exposition of the heel's bone and Achilles tendon. There was not a clear sensory disorder in her fingers and the movement of her ankle and toes were intact. During the first surgical operation, debridement of the necrotic tissue was occurred and preparation of the fields for the pediculate flap was done. Then bandage, dressing and splint–making were completed. The second operational surgery was done for designing a flap and during this operation, the sural flap was designed in a boot – shaped way due to the impossibility of covering the defect using the classic method and the obvious need for longer pedicle. In the end, the basis of flap was cut during the third operational surgery and the final reconstruction of the damage was done. Moreover, the soft tissue defect of the donor flap was reconstructed by the cutaneous graft from the medial surface of the thigh of the same foot. Then, the patient was followed for three months.

Findings: The final result of designing the sural flap in a boot – shaped way for this area of lower limbs was remarkable because there were no side effects such as venous congestion, superficial necrosis and the bleeding from the flap's edge and finally, the patient could properly walk. The effects of removing the flap in the donor site and the sensory disorder resulted from removing the flap were trivial and negligible and also, the patient returned to her daily life in almost no time.

Conclusion: A boot-shaped sural flap is one of the best choices for covering the defects of soft tissue of the heel and ankle. In the classic term, it is formed in a rectangular or oval shape but this flap was a versatile flap and can be designed in other shapes for increasing the efficiency of the flap and decreasing the side effects in terms of the shape and size of the defects.