Effectiveness of Reverse Sural Artery Flap in The Management of Wheel Spoke Injuries of the Heel
DOI:
https://doi.org/10.70749/ijbr.v3i3.867Keywords:
Reverse Sural Artery Flap, Wheel Spoke Injuries, Heel Reconstruction, Soft Tissue Defects, PakistanAbstract
Objective: To evaluate the effectiveness and outcomes of the reverse sural artery flap (RSAF) in managing wheel spoke injuries of the heel in a tertiary care setting in Pakistan, with an emphasis on its indications, postoperative complications, and functional recovery. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Department of Plastic and Reconstructive Surgery, PNS Shifa Hospital, Karachi, Pakistan, conducted between August 2024 and January 2025. Methodology: Data were collected from patients treated with RSAF for reconstructive purposes following wheel spoke injuries to the heel. The study included patient demographics, details of the injury, and postoperative outcomes. The main outcomes assessed were complications such as flap necrosis, donor site morbidity, and functional recovery, along with the success rate of RSAF in covering soft tissue defects. Data analysis was performed using SPSS Version 22, with a significance level of p-value < 0.05. Results: RSAF successfully covered heel defects in 90% of cases. In the remaining 10%, minor complications were observed, including partial flap necrosis and donor site issues like scar formation and sensory changes but there were no cases of osteomyelitis or major complications. Functional recovery was excellent, with all patients regaining weight-bearing ability within six months. The average hospital stay was 14–16 days, and follow-ups at 1, 3, and 6 months showed stable flap viability and satisfactory healing. Early intervention significantly improved outcomes, confirming the importance of timely surgery. Conclusion: The reverse sural artery flap is a viable and effective option for the reconstruction of soft tissue defects in wheel spoke injuries of the heel in the Pakistani population. The technique offers reliable coverage and good functional outcomes, with minimal complications when performed in a timely manner. The study highlights the importance of early intervention and appropriate postoperative care to optimize results.
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References
Ali, A. M. (2023). Reverse sural artery flap for posterior ankle soft tissue defect. Al-Azhar Assiut Medical Journal, 21(3), 165–170. https://doi.org/10.4103/azmj.azmj_4_24
Bernardes, R. A., Parola, V., Cruz, A., Correia, N., & Neves, H. (2024). Functional rehabilitation for medial gastrocnemius silent contractures to prevent foot and ankle disorders: A review. Muscles, 3(4), 323-338. https://doi.org/10.3390/muscles3040028
Bissoondial, A. (2024). Designing and Testing a Safe and Adjustable Bicycle for a Child with Achondroplasia (Doctoral dissertation, WORCESTER POLYTECHNIC INSTITUTE).
Blair, J. A., Puneky, G. A., Dickerson, T. E., Faith, H. D., & Davis, J. M. (2022). Posttraumatic soft tissue coverage of the lower leg for the orthopedic surgeon. Orthopedic Clinics of North America, 53(3), 297-310. https://doi.org/10.1016/j.ocl.2022.03.002
Boretto, J. G., Hohman, M. H., & De Cicco, F. L. (2024). Fasciocutaneous flaps. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562280/
Bretherton, C., Al-Saadawi, A., Sandhu, P. H., Baird, P. J., & Griffin, P. X. (2024). Healthcare professionals beliefs and priorities for the rehabilitation of patients after ankle fracture surgery: A qualitative study. Injury, 55(12), 111975. https://doi.org/10.1016/j.injury.2024.111975
Campo, T. M. (2023). Medical imaging for the health care provider. https://doi.org/10.1891/9780826160478
Cvrtak, S. (2024). RECONSTRUCTIVE MICROSURGERY (Doctoral dissertation, University of Rijeka. Faculty of Medicine. Department of Surgery). https://urn.nsk.hr/urn:nbn:hr:184:854499
Domenghino, A., Walbert, C., Birrer, D. L., Puhan, M. A., Clavien, P., Heuskel, D., Man, N. K., Monteiro, J., Perellon, J. F., Pérez Martínez, S., Seedat, S., Urbaniok, F., Woodbridge, J., Barkun, J., Grocott, M. P., Hurst, S., & Witt, C. M. (2023). Consensus recommendations on how to assess the quality of surgical interventions. Nature Medicine, 29(4), 811-822. https://doi.org/10.1038/s41591-023-02237-3
Gilbert, A., Bonny, M., & Arisen, H. (2024). A systematic review of the imaging modalities used for image acquisition. https://doi.org/10.21203/rs.3.rs-5553130/v1
Huang, Q., Wang, Q., Xu, Y., Ren, C., Lin, H., Zhang, C., Liu, L., Li, M., Lu, Y., Li, Z., Zhang, K., & Ma, T. (2023). Dual-perforator flap with wide pedicle versus sural Neurocutaneous flap with peroneal artery perforator in the treatment of soft tissue defects of foot and ankle. The Journal of Foot and Ankle Surgery, 62(1), 150-155. https://doi.org/10.1053/j.jfas.2022.06.003
Hussen, A., Abdel-Megeed, A., Allam, K., & Hasanyn, M. (2023). A comparative study between distally based sural artery flap and medial plantar artery flap in reconstruction of ankle and foot defects. Ain Shams Journal of Surgery, 16(4), 290-299. https://doi.org/10.21608/asjs.2023.325724
Khurram, M. F., & Karad, S. (2024). Versatility of proximal sural island sensate Fasciocutaneous flap in reconstruction of soft tissue defects of knee and proximal leg. Journal of Wound Management and Research, 20(2), 137-144. https://doi.org/10.22467/jwmr.2023.02775
Laterza, V., Marchegiani, F., Aisoni, F., Ammendola, M., Schena, C. A., Lavazza, L., Ravaioli, C., Carra, M. C., Costa, V., De Franceschi, A., De Simone, B., & De’Angelis, N. (2024). Smart operating room in digestive surgery: A narrative review. Healthcare, 12(15), 1530. https://doi.org/10.3390/healthcare12151530
Lippi, L., Ferrillo, M., Losco, L., Folli, A., Marcasciano, M., Curci, C., Moalli, S., Ammendolia, A., De Sire, A., & Invernizzi, M. (2024). Aesthetic rehabilitation medicine: Enhancing wellbeing beyond functional recovery. Medicina, 60(4), 603. https://doi.org/10.3390/medicina60040603
Marais, L. C., Zalavras, C. G., Moriarty, F. T., Kühl, R., Metsemakers, W., & Morgenstern, M. (2024). The surgical management of fracture-related infection. Surgical strategy selection and the need for early surgical intervention. Journal of Orthopaedics, 50, 36-41. https://doi.org/10.1016/j.jor.2023.11.033
Mellow, M. (2022). A Case for Faith Sharing Ancient Secrets for Longer Life, Health and Happiness. Covenant Books, Inc..
Prakash, O., Ali, S. S., Khurram, M. F., & Yaseen, M. (2024). Reverse sural artery flap – A versatile option in distal lower-limb reconstruction. Journal of Orthopedics, Traumatology and Rehabilitation, 16(1), 20-23. https://doi.org/10.4103/jotr.jotr_1_24
Tissue, P. S. (2022). Coverage of the Lower Leg for the Orthopedic Surgeon. Soft Tissue Procedures, An Issue of Orthopedic Clinics, E-Book: Soft Tissue Procedures, An Issue of Orthopedic Clinics, E-Book, 53(3), 297.
Wehner, H., Madea, B., & Rutty, G. (2022). Traffic accidents. Handbook of Forensic Medicine, 1455-1493. https://doi.org/10.1002/9781119648628.ch63
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