• Chenglin Yang, Yanlin Li, Shuo Geng, Chunjiang Fu, Jiabing Sun, and Zhenggang Bi.
• Department of Orthopedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
• ANZ J Surg. 2013 Dec 1; 83 (12): 954-8.

BackgroundWhile free flaps can be used in many cases to cover soft tissue defects in the distal leg and ankle in a single stage, factors such as diabetes and advanced age can interfere with success of vascular anastomoses.MethodsTwenty-five patients with deep tissue exposure of the distal leg and ankle underwent reconstruction with a modified reverse sural adipofascial flap. Seventeen cases were due to trauma (13 due to high velocity trauma). All 17 had anterior tibial soft tissue defects without significant rear calf soft tissue injury. Eight patients had iatrogenic soft tissue defects due to orthopaedic surgeries for fractures. The flap is raised through two small incisions (3-5 cm) in the posterior aspect of the leg and the subcutaneous fat is split such that some is preserved with the skin. Once the flap is in place, it is covered by a full-thickness skin graft and the donor site is closed primarily.ResultsTwenty-one flaps survived. Four had partial loss of the skin graft on the flap, which healed spontaneously without secondary resurfacing. Anatomic contour was obtained in the recipient sites of all 25 patients. All donor sites healed primarily with the preservation of protective sensation in the calf and acceptable aesthetic appearance. Numbness in the lateral dorsal foot improved gradually and only minor residual numbness was noted at 1 year postoperatively.ConclusionsThe modified reverse sural adipofascial flap preserved the sensation of the donor site and the anatomic contour of both recipient and donor sites.© 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

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