Distally based sural neurocutaneous flaps for ankle and heel ulcers

KH Mak
Department of Orthopaedics and Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong

This study assessed the use of sural neurocutaneous flaps to repair chronic ulcers in difficult-to-cover areas around the ankle and heel. Follow-up of the 14 patients included in this study ranged from 6 months to 3 years after their operation. Total flap loss occurred in two patients, both of whom had rheumatoid arthritis complicated by vasculitis. Partial flap loss occurred in three patients; all were heel ulcers. Additional skin grafting procedures were required to cover their ulcers. A lateral malleolus ulcer in a patient with rheumatoid arthritis recurred after 1 year and had to be covered with a free parascapular flap. The sural neurocutaneous flap is thus a reliable means of resurfacing ulcers in the ankle and heel region. It requires no sacrifice of major peripheral vessels and may be a useful alternative for patients with poor peripheral pulses. Its use in the presence of vasculitis, however, needs further refinement.

Hong Kong Med J 2001;7:291-5

Key words: Achilles tendon; Foot ulcer/surgery; Leg ulcer/surgery; Sural nerve; Surgical flaps