Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns
Abstract Background The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outc...
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| Format: | Article |
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SpringerOpen
2025-08-01
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| Series: | Journal of Orthopaedics and Traumatology |
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| Online Access: | https://doi.org/10.1186/s10195-025-00860-z |
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| author | Saleh Abualhaj Mosleh M. Abualhaj Mohd Said Dawod Maher Alkhateeb Eyad Alqarqaz Mohammed Jaber Rasha Al-Ebbini Mohammad Alananzh Lina alshadfan |
| author_facet | Saleh Abualhaj Mosleh M. Abualhaj Mohd Said Dawod Maher Alkhateeb Eyad Alqarqaz Mohammed Jaber Rasha Al-Ebbini Mohammad Alananzh Lina alshadfan |
| author_sort | Saleh Abualhaj |
| collection | DOAJ |
| description | Abstract Background The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited. Methods This retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan–Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site. Results A total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months. Conclusions RSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study). |
| format | Article |
| id | doaj-art-694c02e0707a480eb409d79a42aee17f |
| institution | Kabale University |
| issn | 1590-9999 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj-art-694c02e0707a480eb409d79a42aee17f2025-08-20T03:46:27ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992025-08-0126111010.1186/s10195-025-00860-zReverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patternsSaleh Abualhaj0Mosleh M. Abualhaj1Mohd Said Dawod2Maher Alkhateeb3Eyad Alqarqaz4Mohammed Jaber5Rasha Al-Ebbini6Mohammad Alananzh7Lina alshadfan8General Surgery Department, Faculty of Medicine, Al-Balqa Applied UniversityDepartment of Networks and Cybersecurity, Al-Ahliyya Amman UniversitySpecial Surgery Department, Faculty of Medicine, Mutah UniversityPlastic Surgery Department, Royal Medical ServicesGeneral Surgery Department, Faculty of Medicine, Al-Balqa Applied UniversityPlastic Surgery Department, Al Basheer HospitalKing’s College London NHS FoundationDepartment of Special Surgery, Faculty of Medicine, Al-Balqa Applied UniversityDepartment of Pediatrics, Faculty of Medicine, Al-Balqa Applied UniversityAbstract Background The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited. Methods This retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan–Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site. Results A total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months. Conclusions RSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study).https://doi.org/10.1186/s10195-025-00860-zReverse sural artery flapRSAFLower extremity reconstructionSoft tissue defectsFlap survival |
| spellingShingle | Saleh Abualhaj Mosleh M. Abualhaj Mohd Said Dawod Maher Alkhateeb Eyad Alqarqaz Mohammed Jaber Rasha Al-Ebbini Mohammad Alananzh Lina alshadfan Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns Journal of Orthopaedics and Traumatology Reverse sural artery flap RSAF Lower extremity reconstruction Soft tissue defects Flap survival |
| title | Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns |
| title_full | Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns |
| title_fullStr | Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns |
| title_full_unstemmed | Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns |
| title_short | Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns |
| title_sort | reverse sural artery flap for lower extremity reconstruction a multicenter retrospective analysis of success and failure patterns |
| topic | Reverse sural artery flap RSAF Lower extremity reconstruction Soft tissue defects Flap survival |
| url | https://doi.org/10.1186/s10195-025-00860-z |
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