Value of distal base sural flap (interosseous flap) - A clinical study

Abstract

Introduction: Distal Base Sural Flap is a very important flap to cover the posterior as well as weight bearing area of heel with single rotation flap. The indications include post traumatic defect with compound communited fracture calcaneum with partial or complete rupture of tendoachilles, squamous cell carcinoma over heel following non-healing ulcer, and non-healing ulcers over heel due to other causes. Materials and Method: Skin and deep fascia of leg are incised from proximal to distal, sacrificing the sural nerve and the short saphenous vein. The flap medially follows the lateral border of the Achilles tendon, and laterally the fibula. When defect is on heel, the medial incision can reach the edge of the defect. The flap is then rotated at 180⁰ to cover the defect. Functional and aesthetic outcomes are evaluated in terms of complete or partial flap survival, successful coverage of the recipient defect, healing of any underlying fracture proved radiographically, ease or difficulty in walking or wearing shoes, ambulatory status of the injured limb after six months and any concerns of the patient regarding the aesthetic appearance of the flap. Donor site healing and complications are also recorded. Results: We have done 10 cases using this flap and got 8 excellent results, 1 good and 1poor result. Our maximum follow up period is of 2yrs and minimum is of 6months. Conclusion: Distally based sural flap is an excellent procedure in selected cases for covering the defect. Patients are back on his/her own feet within short time and able to put full weight without any complication in follow up period.