Ceccaroni Alessandra, Cuomo Roberto, Pentangelo Paola, Gentile Antonioenrico, Marra Caterina, Rozen Warren Matthew, Seth Ishith, Lim Bryan, Alfano Carmine
Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy.
Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, Santa Maria alle Scotte Hospital, University of Siena, 53100 Siena, Italy.
Medicina (Kaunas). 2024 Dec 13;60(12):2053. doi: 10.3390/medicina60122053.
Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success.
下肢软组织重建面临重大挑战，尤其是在处理小腿远端三分之一、踝关节和足部的缺损时。依赖腓动脉穿支的逆行腓肠神经营营皮瓣已成为一种多功能选择，为无法采用显微外科技术的患者提供了一种解决方案。尽管该手术有其优点，但也存在固有风险，特别是在患有潜在疾病的人群中，如静脉功能不全、心血管疾病和糖尿病患者，以及老年患者，这些人群皮瓣坏死的可能性会增加。本报告详细介绍了一例狼疮样综合征患者发生逆行腓肠神经营营皮瓣坏死的病例，这一复杂情况凸显了术前进行细致评估和规划的必要性。该病例不仅说明了与逆行腓肠神经营营皮瓣相关的技术考量和挑战，还体现了系统性自身免疫性疾病对术后结果的更广泛影响。通过对文献的全面回顾，我们探讨了血管化、自身免疫状况与逆行腓肠神经营营皮瓣手术成功率之间的关系。我们强调外科医生必须采取整体方法对患者进行评估，要考虑到可能影响皮瓣存活能力和整体重建成功的局部和全身因素。
