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Title: Comparison of Distally Based Sural Fasciocutaneous Island Flap with a nd without Inclusion of Sural Nerve
Authors: Tabish Samuel, Shahid Hameed, Abdul Majid, Shahid Hussain Naqvi, Shah Faisal, Farman Mehmood
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2022
Volume: 72
Issue: 6
Language: English
DOI: 10.51253/pafmj.v72i6.4522
Keywords: Distally based sural fascio-cutaneous FlapDistal lower limb flap coverage
Objectives: To compare the inclusion and exclusion of the sural nerve in fascio-cutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation and complications.
Study Design: Prospective comparative study
Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Mar 2020.Methodology: A total of 54 patients (27 in each Group) requiring distal lower limb flap reconstruction and meeting the inclusion and exclusion criteria were included. Patients with a higher probability of flap complications and those with complications during the procedure were excluded. Group-A patients underwent fascio-cutaneous flap repair with sural nerve preservation, while Group-B patients underwent the same technique, but the sural nerve was transected and raised with the flap. All patients were followed for flap survival, flap size and degree of sensory recovery and flap-related complications.
Results: Varying degrees of return of sensation were seen in 25(92.6%) patients of Group-A after six months, which was 23(63.1%) in Group-B (p<0.001). Flap survival was comparable in both groups: 26(96.3%) and 25(92.6%) patients in Groups A and B, respectively (p=0.552). The complications were also comparable, 4(14.8%) in Group-A and (25.9%) in Group-B, which was not statistically significant (p=0.209).
Conclusion: Preservation of the sural nerve results in little or no sensory loss in the lateral part of the foot, with complication rates and flap survival comparable to cases where the nerve is sacrificed.Keywords: Distally based sural fascio-cutaneous Flap, Distal lower limb flap coverage, Sural nerve preservation.
To compare the inclusion and exclusion of the sural nerve in fasciocutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation, and complications.
Prospective comparative study involving 54 patients divided into two groups (27 each). Group A underwent fasciocutaneous flap repair with sural nerve preservation, while Group B underwent the same technique with sural nerve transection. Patients were assessed for flap survival, flap size, sensory recovery (using the Mackinnon-Dellon scale), and complications. Data was analyzed using SPSS version 25.0 with Chi-square and Independent sample t-tests.
graph TD;
A["Patient Recruitment & Group Allocation"] --> B["Perform Fasciocutaneous Flap Repair"];
B --> C["Group A: Sural Nerve Preservation"];
B --> D["Group B: Sural Nerve Transection"];
C --> E["Post-operative Assessment"];
D --> E;
E --> F["Data Collection: Flap Survival, Size, Sensation, Complications"];
F --> G["Statistical Analysis"];
G --> H["Conclusion & Discussion"];
The study suggests that preserving the sural nerve leads to better sensory recovery in the lateral foot with comparable flap survival and complication rates to cases where the nerve is sacrificed. While flap size and pivot point measurements showed some differences compared to other studies, the overall flap survival was high in both groups. The anatomical variations of the sural nerve were also documented and found to be largely consistent with existing literature.
- Varying degrees of return of sensation were observed in 92.6% of patients in Group A (nerve preserved) compared to 63.1% in Group B (nerve sacrificed) after six months (p<0.001).
- Flap survival was comparable between the groups: 96.3% in Group A and 92.6% in Group B (p=0.552).
- Complication rates were also comparable: 14.8% in Group A and 25.9% in Group B (p=0.209).
Preserving the sural nerve in distally based sural fasciocutaneous island flaps for lower extremity reconstruction results in significantly better sensory recovery with no detrimental effect on flap survival or complication rates. This approach spares the patient from donor site anesthesia and retains the nerve for potential future reconstructive needs.
- A total of 54 patients were included in the study, with 27 in each group.
- After six months, 92.6% of patients in Group A showed varying degrees of return of sensation, while 63.1% in Group B did.
- Flap survival was 96.3% in Group A and 92.6% in Group B.
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