The Reverse Sural Fasciocutaneous Flap in Lower Extremity Reconstruction: A Critical Review of Indications, Technical Modifications, And Clinical Outcomes
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Abstract
Background: Reconstruction of soft-tissue defects in the distal third of the leg, ankle, and foot represents one of the most complex scenarios in reconstructive surgery due to the scarcity of local tissue and frequent exposure of noble structures. The reverse sural fasciocutaneous flap (RSFCF) has emerged as a robust local alternative to microsurgical free flaps.
Objective: To critically evaluate the clinical efficacy, anatomical basis, applications in special populations (trauma, diabetic foot ulcers, oncology), and the impact of surgical modifications on the survival rate of this flap through a synthesis of contemporary literature.
Materials and Methods: A systematic analysis of scientific evidence provided by recent meta-analyses, institutional comparative studies, and clinical case series evaluating the success and complication rates of classical and modified reverse sural flaps was conducted.
Results: The overall flap survival rate is approximately 95.2%, with a major complication incidence of 14.8% in its classical form, venous congestion being the primary adverse event (75.3% of complications). The implementation of technical refinements such as venous supercharging and the adipofascial variant significantly reduces overall failure rates to less than 1% and complications to 1.5% and 11%, respectively. In chronic diabetic foot ulcers, the flap achieves a weighted healing rate of 93.3%, demonstrating that factors such as active smoking and venous insufficiency are more predictive of failure than diabetes per see.
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References
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