Distally Based Sural Artery Flap Health And Social Care Essay

Introduction

Soft tissue coverage of lower appendages defect is disputing to both plastic and orthopaedic sawboness. Lower appendage is prone to trauma and jeopardies due to its location and low vascularity.

Unlike trunk, there is limited figure of flap picks available for Reconstruction of lower limb defects. These flaps should be able to cover the defect specially any open bone, nervus, sinew or any major vass ; besides it should be easy to execute and give permanent consequences to patient.

The really fist documented thought of fasciocutaneous flap was presented in 1980 by Poten, and that resulted because of advanced cognition and survey of anatomy of lower particularly in footings of neurovascular construction, muscular structure, and blood supply to clamber and deep facia. Poten described and emphasized upon the function of fasciocutaneous flap for Reconstruction of lower leg defects due to their dependability and safety profile.

Upper and lower appendages have longitudinal dispersed superficial nervousnesss and hypodermic venas. It is advised that fasciocutaneous flaps should integrate these nervousnesss and venas which help in flap endurance and diminish the ratio of flap mortification and best illustration of such fasciocutaneous flap is sural arteria flap which is based on average superficial sural arteria which is a subdivision of superficial Sural arteria.

The pedicel sural flap consists of superficial and deep facia, lesser sephanous vena, average superficial little arteria and sural nervus, whereas the flap consists of tegument with hypodermic tissue and facia along with above mentioned neurovascular constructions.

Methodology

This prospective interventional survey was conducted form March 2007- February 2009 at the Department of Plastic Reconstructive Surgery and Burns Unit, Liaquat University of Medical Health Sciences, Jamshoro. During the survey period patients coming for coverage of lesion on lower appendages were included in the survey after obtaining informed consent. A predesigned proforma was used to roll up the data.. Patients were followed for a period of six months. SPSS 17 was used for informations analysis

After all sterile steps the flap was raised. All patients were operated under spinal anaesthesia. After application of compression bandage, the surface markers were drawn at the sidelong boundary line of Achilles tendon medically and laterally at the border of fibular shaft. At sidelong malleolus a sidelong scratch is made, the median scratch is made at the sidelong boundary line of Achilles sinew which continues till the point of its interpolation at border of defect or tubercle of calcanium.

After scratch on tegument and facia, the short sephanous vena is ligated and sural nervus is divided. Flap is than raised distally, subdivisions of peroneal arteria are included in sub facial fat in the flap to guarantee maximal blood supply. Flap is so advanced along the sidelong border of Achilles sinew. Donor side is so near chiefly if flap is little in size, otherwise natural surface is covered with partial thickness tegument grafting. After a period of 3 hebdomads the flap is detached and its distal portion is stitched back to its original location.

Consequences

Sural flap was done in 35 instances. Patient ‘s age ranged from 13-57 old ages with Mean±SD age of 31±7.7 old ages. There were 29 males ( 82.85 % ) and 6 females ( 17.14 % ) . Majority of patients were between 31-40 twelvemonth of age Table I.

All flaps were survived, partial tip mortification was seen in 3 patients ( 8.57 % ) , and remainder had good viability of full flap. Mode of hurt was route traffic accident in bulk of instances i.e. 30 patients ( 85.71 % ) . Two immature males ( 5.71 % ) with radius wheel hurt. Two patients had force per unit area sore lesions. One patient ( 2.85 % ) has exposed calcanium due to fire hurt. Paresthesia on sidelong boundary line of pes resolved on its ain within 6 months period in all instances, there was no neuroma formation.

Discussion

Reconstruction of lower appendage defect are still an mystery for fictile sawboness working in a apparatus where microvascular surgery installations are non yet available. The most common site is heel which is a weight bearing country and is prone to trauma and other jeopardies like force per unit area sores. The tegument over the heel is less nomadic and has hapless blood supply. Following rehabilitative ladder several options have been studied for soft tissue coverage of open heel including septo cutaneal, axial form, random form, musculus flap and free flaps. So far, fasciocutaneous flaps are proven to be an armamentarium for fictile sawbones, particularly when it comes to Reconstruction of lower appendage defects. Though many writers are of sentiment that medical plantar flap is the best option for coverage of open heel. However others are of sentiment that sural arteria flap offers the same. Viability of island flaps are ever questionable due to cut down blood supply, another option for coverage of open heel defects is sidelong calcaneal flap which is based on sidelong calcaneal arteria, it besides contain lesser sephanous vena and sural nervus. However once more it has a short coming o tantrums little size, that ‘s why it is non ever suited for open heel defects particularly larger in size.

Distally based contrary flow sural arteria flap is option of pick since 1980s. it is based on median superficial sural arteria. The blood flow is in contrary from the peroneal arteria in distal portion of leg. Small nervus besides has its ain arterial supply. These all subdivisions anastomosis freely in superficial plane.

Many writers have reported that distally bases sural artery flap as a versatile and dependable flap for Reconstruction of lower appendage defect. Several surveies have reported experience of coverage of calcaneal and malleolus defects with good result with sural flap. The major drawback of this flap is forfeit of sural nervus ; nevertheless surveies report that the esthesis improves over the period of clip and same was the instance in this series on a 6 months follow-up.

Decision

It is concluded that distally based sural arteria flap is an first-class option for coverage of soft tissue defects of lower appendage, specially exposed calcanium and malleolus due to its first-class blood supply.