BACKGROUND: The coverage of soft tissue defects of the distal leg, ankle or foot poses several challenges to the reconstructive surgeon. Reconstructive procedures may range from simple skin grafting to complicated free tissue transfers. The reverse sural flap has been one of the most dependable methods for soft tissue coverage of such complex wounds. The purpose of this paper was to compare the clinical results of reverse sural flaps harvested with a fascial versus a fasciocutaneous pedicle.

METHODS: A retrospective cohort of twenty-six patients who underwent a reverse sural flap procedure for complex wounds of the distal lower extremity was examined from January 1, 2003 to December 31, 2009, with a minimum follow-up of one month. Fifteen patients had a fascial pedicled flap, while eleven patients had fasciocutaneous pedicled flaps with a minimum of one month follow-up. The primary outcome was flap-related complications. Fisher's exact test was used to determine the differences between the two groups and the level of significance was set at p?0.05.

RESULTS: All flaps survived. Flap-related complications were more common in the fascial pedicled flap (6/15) compared with the fasciocutaneous pedicled flap (1/11). The difference was not significant (p=0.09). In terms of cosmetic acceptability, 11 patients (11/15) in the fascial pedicle group and five patients (5/11) in the fasciocutaneous pedicle group expressed that the sural flap was acceptable.

CONCLUSION: Reverse sural flap was a reliable reconstructive procedure for coverage of soft tissue defects of the distal leg, ankle or foot. There was no significant difference in terms of complication rates for those with fascial compared with those with fasciocutaneous flaps. Cosmetic acceptability was higher for the fascial pedicled flap.