• Kyeong-Hyeon Park, Chang-Wug Oh, Joon-Woo Kim, Hyun-Joo Lee, and Hee-June Kim.
• Department of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
• Injury. 2023 Aug 1; 54 (8): 110915110915.

BackgroundThe reverse sural artery fasciocutaneous (RSAF) flap is a popular option for patients with soft tissue defects of the distal lower extremities. However, most studies have focused on young patients without comorbidities. This study aimed to report the clinical application of the RSAF flap and to evaluate its reliability in older adult patients.MethodsA retrospective study of fifty-one patients who underwent RSAF flap was included in this study between September 2016 and October 2021. Reconstruction outcomes and wound complications were compared between groups A (21 patients over 60 years of age) and B (30 patients under 60 years of age).ResultsOverall, 74.5% of the flaps healed primarily. The demographics of the two groups were similar, except for comorbidities (P = 0.01). The risk factors that affected the survival of RSAF flaps were not significantly different between the two groups (P > 0.05). The rate of wound complications in group A (42.85%) was significantly higher than that in group B (13.3%) (P = 0.04). However, all wound complications were treated using a simple procedure (skin grafting or simple suturing).ConclusionsThe RSAF flap can be a reliable salvage option to repair soft tissue defects of the lower extremities in older adult patients. It is safe and easy to harvest and transfer the flap; however, surgeons should be aware of the possibility of wound complications in older patients with comorbidities.Copyright © 2023. Published by Elsevier Ltd.

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