Clinical outcomes of the reverse sural flap when performed by orthopaedic trauma surgeons

Objectives:To evaluate reverse sural flap (RSF) outcomes when performed by nonmicrovascular trained orthopaedic trauma surgeons.Design:Retrospective cohort.Setting:Single level 1 trauma center.Patients:Seventeen patients undergoing RSF for soft tissue coverage of distal 1/3rd leg and/or hindfoot wounds. All patients were managed and followed by 2 nonmicrovascular trained orthopaedic surgeons until RSF healing or failure.Intervention:Reverse sural flap for coverage of distal leg and/or hindfoot wounds.Main Outcome Measurements:RSF survival, percent viability, healing time, and cosmetic outcome. Patient demographic data, comorbidities, and indication for coverage were evaluated in relation to flap survival.Results:Flap viability was noted in 14/17 patients, with 3/17 patients experiencing RSF necrosis or failure. Two of three flap failure cases presented with surgical site infection after RSF. The remaining flap failure resulted from an inability to follow weight-bearing restrictions leading to flap shearing and coagulation. Diabetes was present in 2 of 3 flap failure cases. Cosmetic outcomes among the surviving flaps were excellent or good in 12/14 patients, with an average soft tissue healing time of 57.4 days (23-116 days).Conclusion:The RSF is a powerful and reliable technique for soft tissue coverage of the distal leg and hindfoot that can be performed without microvascular training.Level of Evidence:Therapeutic Level IV.