Background: Reverse sural artery flap is a useful flap for defect reconstruction in the distal leg, ankle and heel. The major problem encountered with the reverse sural artery flap is its unreliability. It may be compromised by venous congestion and peripheral arterial insufficiency when the flap is transferred with its pedicle tunneled subcutaneously.
Methods: In this study we describe modifications of this procedure consisting of a wider pedicle during flap design and transferring it without passing the pedicle through a subcutaneous tunnel. The pedicle is then divided in a second-stage operation. Four patients with defects at various locations over the distal leg and heel had reconstruction with reverse sural artery flap in this fashion.
Results: No failure developed among these cases and the wounds healed without complication. These patients were satisfied with this procedure.
Conclusion: Reverse flow flap vascularity is maintained and its viability is ensured with this technical modification.