El-Diwany Mostafa, Karunanayake Mihiran, Al-Mutari Sultan, Duvernay Alain, Danino Alain Michel
Department of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Department of Maxillofacial and Plastic Surgery, General Hospital, Teaching Hospital of Dijon, University of Burgundy, Dijon, France.
Eplasty. 2015 May 12;15:e16. eCollection 2015.
The distally based neurofasciocutaneous sural flap is central to the armamentarium for the reconstruction of leg's distal third, ankle, and hindfoot. Despite the use of adapted techniques aimed at increasing the flap's reliability, venous congestion remains a frequently encountered problem. We present a venous super-drainage technique used by the senior author to reduce venous congestion and improve flap reliability when harvesting larger flaps.
A retrospective chart review, from January 2002 to October 2008, at 2 tertiary care centers, was conducted on all cases of inferior limb reconstruction with reverse sural flaps on defects greater than 10 × 5 cm. In addition, a literature review was carried out to examine the average sural flap surface area and reported complications published from 1992 to 2012. We then compared our results with those published in the literature.
A total of 15 flaps were identified. Mean flap dimensions were 14 × 8.5 cm (mean area = 115.27 cm(2); 95% confidence interval, 99.28-131.26). None of the flaps developed complications (arterial or venous insufficiency, partial/complete necrosis). The average flap surface area in the literature is 55.08 cm(2), with a 22% rate of total complications. We harvested significantly larger flaps (P < .001) with a significantly lower total complication rate (P < .05) when compared with that reported in the literature.
Anastomosing the proximal end of the lesser saphenous vein with a vein at the defect site improves venous outflow, effectively reducing the incidence of venous congestion, increases the potential flap size, and improves reliability.
以远端为蒂的腓肠神经营养血管皮瓣是修复小腿远端三分之一、踝关节和后足的重要手段。尽管采用了旨在提高皮瓣可靠性的改良技术，但静脉淤血仍是一个常见问题。我们介绍一种资深作者使用的静脉超引流技术，以减少静脉淤血并提高切取较大皮瓣时的皮瓣可靠性。
对2002年1月至2008年10月在2家三级医疗中心进行的所有采用逆行腓肠皮瓣修复大于10×5 cm下肢缺损的病例进行回顾性图表分析。此外，进行文献综述以研究1992年至2012年发表的腓肠皮瓣平均表面积及报道的并发症。然后将我们的结果与文献报道结果进行比较。
共确定15例皮瓣。皮瓣平均尺寸为14×8.5 cm（平均面积 = 115.27 cm²；95%置信区间，99.28 - 131.26）。所有皮瓣均未出现并发症（动脉或静脉功能不全、部分/完全坏死）。文献中皮瓣平均表面积为55.08 cm²，总并发症发生率为22%。与文献报道相比，我们切取的皮瓣明显更大（P < .001），总并发症发生率明显更低（P < .05）。
将小隐静脉近端与缺损部位的一条静脉吻合可改善静脉流出，有效降低静脉淤血发生率，增加皮瓣潜在大小并提高可靠性。
